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POTT. L.W.
Lectures on Surgery.
1[8]773-4.

Mr. Potts Surgical Lectures A.D. 73. and 74.

Mr. Potts Lectur/s
on Surgery.
The Introduction
Gentlemen 
My Intention in the following Course of Lectur's
is to treat on the Useful and Important Science
Surgery; and shall not Concern myself in Giving You
a Minute Anatomical Knowledge, or Description
of the Bark; but merely so much as will be hurt
Necessary for our own Purposes, This where I to doe
would be Altering the Plan of My Lectur's; and 
therefore must Defer You to Your Anatomical
Teachers and Books. My Intention is merely to give
you the Practical Parts of Surgery, and which
I shall Endeavour to Say before you, in the most Clear
and Precise Manner that I am Able; some have
Disput'd it being a Science/ others an Art; but it most 
certainly Justly Claims the former. It is needless
to Urge any Encomiums upon on its rise As it is so 
Clear and evident to all Mankind; It was Instruct'd in 
the earliest Times, and different Methods was Pursued
to become the Surgeon; come merely by Perusal

of Books, and Attaind only theory, and there
became by far the Ablest Surgeons in the Closet,
and were apt in Conversation y but in the Practice x
Part where very greatly Deficient, and frequently
at a Loss. And on the other Hand those Introdu'd
by Practise, only wth. the Use of Reasoning or Books,
Labour under an equal Disadvantage, in being
Able to Perform an operation, Dexterously without
perhaps Knowing why it should be done or when it 
is necessary. Different Writers have followed different
Plans, all of which are equaly Defective, and in 
this Particular, they have Confind themselves
in Describing the Modes of Operations merely
wth only wing? You a Clear Account of the Disease,
which requires the operation; they have Given you
the operating Part without Mentioning any Disease
or Prohibitions to any Operation which [Da???]
many Principal Writers [cross out] Labour under; it may
perhaps be Expect'd of Me as is Usualy the Case in
Introductory Lectur's of this Kind, to Give You
an Abstract History of Surgery, which I [cross out] had a 
Power or Capacity to does would Ingross too much of 
that time which I think can be better Employ'd in Parts 

more Beneficialy and Instructive to You; or should 
I do it, it would be only giving You a Series of names
and States. However any one who has Curiosity in him
to Desire to Know this will find the History fully
mention'd in Galens History of Surgery, Clarkes
Surgery; or by Dr friends; the Majority of Writers
have fined a Numerous han of Bandages, and 
Instruments. The first is almost Unnecessary and in
general Prejudicial, nor is is Worth my while to 
Describe them, or Yours to Hear them; the Instruments
are also tedious and Unnecessary, they are very numerous
and an operation was never Perform'd without a great
many of them being Us'd; the Surgeon was never
Imagin'd, unless he produced, or was posses'd and
[illegible] a great number of Instruments; on the 
Contrary I think they cannot be too simple, and
simplicity wth. Respect to Bandages, as well as 
there is always to be Commend'd. There few Bandages
and Instruments which are Useful cannot be too 
Simple, I shall at a proper time Place [crossed out] Describe
them to You; Whoever has the Curiosity to become
Acquaint'd wth. them will find them fully Describ'd
by Scaltehia, and likewise that general Compiler 

of Surgery Neistery this will Instruct You in the 
Choice of Instruments, they are well Described and 
You will find also their Uses. The Methods the 
Teachers of Surgery have follow'd in this. Van
Norn as Divid'd into the ten following Parts, or
Smthutic under which are Dang'd all fractures
Wounds Ulcers and Bruises. The Diabetic; as the
Operation for the hepan, the Eartic or the 
Extraction of Stones, or any rousing Bodies.
The Chartic, as the Extracting of Polypus Excursions,
the Prosthetic, as the Putting in of artificial teeth,
Ey's and Woodan 1 Leg's and Dicorhetic as the 
Management of in Curvat'd Spines. Limbs and 
Clubb feet; and this Plan is regular and very
Superficial, but not at all to be Copied in a Course
of Chirurgical Lectur's. It is Confin'd to the 
Operative Part moraly, a Part very Necessary
to be known, but it Heads not to the Knowledge 
of Diseas's. A Young Man by Studying this method
woud become an Operator, without Knowing why to 
Perform the Operation. He may perhaps doe it when
not necessary Dexterously. First become Clearly
Acquaint'd wth the Nature of the Disease, than where 

the Symptoms shall In. Indicate the operation
and lastly Perform it in the best safest and easiest
Manner as Possible. In Order to render You Capable
to accomplish, thinks may Intention in the following
Course of Lectur's, and which I shall Endeavour to Lay
before You in the most Simple Manner. My Plan
is to make My five or six first Lectur's general,
and to Speak of those Diseas's which are Confin'd
to Particular Parts but are liable to happen in all
Parts of the Body, and having finish'd those begin
wth. the Scalp; and so End regularly wth. the 
Extremities. The Art of Surgery cannot have
too much Said in it Praise, it Unto quite, and 
it Utility, and when properly and Honestly
Practic'd cannot be Deserving of too much Praise.
The Utility of Surgery is well Known to every Rational
Man, Whoever Deflects on the Diseas's liable to be Inflict'd
wth on him, and the Body will immediately on this 
Proposition; Was not the Stone extracted out of the
Irritat'd Bladder what must not evidently have been
the Consequence; On the Contrary the Fracture of a Bone
by proper Position and Assistance of Bandage care,
and Reduction of it may be Accomplished and in 
and in Time the Reunion of the Bone and a Happy Cure.

A Bleeding Vessel, also Point out it Utility, 
for without the immediate assistance of Surgery the 
Patient will Die from the Loss of Blood, the Surgeon
from nearly a fatal End will Restore the Individual,
to his former h Strength, and Health. must more 
might be Said to Elucidate its great Importance are
its Utility. but these Instances Clearly Points it
out, and the best Speaks in Own Praise; Many
People I am Sorry to say it (Consider Surgery under
too different Lights. If Practising only for the 
Sakes of getting a Livelyhood, very little Art
and Abilities are then requir'd, but Considering it as
a great a noble Science it Requires Steady
Applications. Abilities and Integrity; and as You
get this Requisite Acquisition, You will Despise
and Abominate the other; the Surgeon should be well
Acquaint'd wth. Plain [crossed out] Anatomy, that is the Muscular
Parts and especially their Us's, and Simaliar,
when Contract'd and when Relax'd, he shoud under [under???]
the Constitution of every Joint, and the whole of what 
is Call'd the the Animal Œconomy, such as Digestion
from the Mastication of the food, in Passage to the 

Stomach and Stay [illegible] there, and then the formation
of Part of it into the Junction of Bile, and the Conversion
of the food into fœces and Expulsion per Anum, and 
without which he cannot Obtain a Compleat Knowledge
of Surgery. This will Undoubtdly take up some time
it is at the first Difficult, but is easily attaind
by a little Cloose Applicaion, and Perseverance.
A Surgeon shoud not only Know Anatomy but should
have a Competant it Knowledge of Physics and
shoud be very well Acquaint'd wth. the Action and 
Quality of Medicines, As in the Country he cannot 
have the Assistance of Calling in a Physician. A 
Compound Fracture in the first Place will take on Inflamation
and Febrile Symptoms Attending it, which will
Require Medical Assistance, in the last State of it will
from it many Symptoms require a Different and 
Careful Treatment; Surgery not only Consist in Pleuing
the Limb in an Advantageous easy Position or
Dressing or Turning it wth. great neatness and 
Dexterity, this will not Deceive a Patient of his 
Principal Complaints, He may Sink from a Diarrhea
Dysentery or Diabetes, and He must have Medical
Assistance. If therefore Behooves You to be well 

Acquaint'd wth. there the Complaint for the 
Removing of them, or You will kindly annals greatly
Embarrass'd; and from the Meriti that Reputation
which ever Distinguishes a good Surgeon.
Anatomy and Physiology are absolutely necessary
make the Surgeon to there should be added natural
Physiology it ought therefore to from Part of your
Studies, as that will Point out to You the Beauties
which attend the Noble Science, and greatly assists
the natural Genious, and Explains to Us the 
many Divisions Nature sometimes Puts on and
to these must be added, and Temperate Steady
and Resolute Patients Injuring and not Bias'd
by Prejudices, and not to be Led by the first 
appearanc's as Not in Unmanly his Resolution
shoud by no means Lead him to Barbarity or He 
shoud make a Distinction between the Senseless
Dead and Sensible and the [illegible] Irritable
Parts of a Miserable and Unhappy but falling
Patient; thus are the branch in Falling to a Cruelty
in their Operations. Who on reading their Tracing of the 
Spermatic Chord Five or Six Inches up into the Abdomen
for the Removal of Schirrus Testicle and Chord

could ever suppose they ever did it but on an 
Animal Body or that if otherways less than Mad Men
for the Attempt. Now they doe this cannot be Conceiv'd
by a Rational Surgeon, Yet if they Lay this Down 
as a Matter of part, and that have been Produc'd, I can not
Preceive that this has ever been Peform'd but on the 
Dead Body. When a Surgeon Comes in Practise in the
Highest Sphere and is often Calld upon, He must
have other Necessary the Qualifications) An Eye an
Hand and Temper; this Eye is as Gold Pleaser to 
give him, is Hand may if Defective may be Owing 
to himself and his Intemperance; therefore in a 
Surgeon to Live a Temperate Life; His Temper shoud
be mild and be engaging, and not to frighten the 
Irinarous without the Appearance of Brutality
which is always to be command'd, and for a farther
Recital for their a Accomplishment and Necessary
Qualifications belonging to a Surgeon, I will Defer
You to Surgical Writers who have fully treat'd of it,
that a Physician will always be the best Practitioner
who has a a Knowledge of Surgery, and in like Manner the
Surgeon who is the Acquaint'd wth. the Use and Quality
of Medicines, Writers in Surgery may be Divid'd into 
Two Classes those of general System, and those of 

particular Diseas's; the former have not Time enough
to kill as Minute Diseas's they doe little more 
than Give out Lines and Copy from Another; the 
latter You should lead more Attentively, and Pay
always more Respect to Yourself, and Let Your  
own Judgement be always Accompanied wth. this
System Comparing it with Your own Observations,
and Practise Shews to You And then Act accordingly,
Surgery has within these 50 Years been Improv'd very 
much, but Let not that excite Your Vanity, but tend
rather to excite Your Ambition, by Assiduity and
Study farther Improvements, for no Doubt some 
Years hence Our own Successers will be as much 
Astonished at our Ignorance, as We are at our 
Predecesours; Many Useful Improvements, We Owe
to their Use, from wch Fool hardy Practitioners
and Ignorant Quacks; Thus was the Present Later a 
Operation for the Stone, Invent'd by one From Jacques
a Person of no Education. Therefore Knowledge
may be beg of from the Ignorant as well as the Learn'd 

and indeed most of the Useful Discoveries in 
Physick and Surgery have been Effect'd through Ignorance
and Chance. Now Whidaly different is the Small Pox
to what it was a few Years ago, I woud always Have 
in Medicine between the Custom Practise of Religious
well Meaning Practitioners; and the Foolish Variable
Practise of others, nor ever Listen too greedily to 
my sudden New Putting Practise, before You have 
thoroughly Consider'd it; Now with Respect to Your
Studies Compare Your Reading with Your Observations
that You may be able to Form Distinctions and 
Differences, which You may Regulate in Your Notes;
the frequent Dissections of Dead Bodies is absolutely
Necessary, To know the Situation of Parts and 
how Construct'd &c. This will Give You above the 
Rest the sole use of Your Hand in Respect to the 
Operative Part of Surgery, and which cannot be 
Obtaind but by a Dissection. In Performing 
an Operation, always Remember You have a 
Body before You, indeed wth. the greatest Degree
of Sensibility, and wth. the most exquisite healing
therefore Give the least Possible Pain Imaginable

be not too Quick nor Strive to Shew Your
Dexterity, by doing which You may Cut Parts
which ought not to be Cut. but be Calm and 
Let this be a general Rule with You, if its well
done its soon done; I have now only to add, if I shall
Give You any Knowledge in these Lectur's, which
is My Intention to doe; You Oblige me by Improving
it by study and assiduity and then to Practise
as an Honest and Judicious Surgeon- 

Lecture 
On Tumours 1st.
Before the Discovery of the Circulation of the 
Blood and before the general Distinction of the Fluids
through the Body, owing, it was thought the Principal
Fluids where from (viz) Blood, Bile, and Pituatar
and Anobitis, or the Melancholy; and that these when 
and or due Regulation, where not only necessary to, but
even the Source of Health; it was likewise Supposd
that the Redundancy or Dimination of these Fluids
or Numours, was the Cause of Different Kinds of Tumours
Namely Phlegmonous, Erisipelas, Œdema, and 
Schirrhous, that these Opinions are foundd on
Matter of Fact, is hard by necessary to Observe; in
this Place We still keep up the Manner of Distinguishes
Tumours into four Classes, because We find
the Divisions are very natural, and that all four 
Require different Kinds of Cure, the Phlegmond
is not Confin'd to any particular Part of the 
Body, but it may happen any where; Its more or less
a hard Circumsensible & Tumour, it attend'd with [illegible]

Degree of Pain, and Puts on an Inflamatory
Appearance of a higher red Colour, the Patient
has frequently some Degree of Symptomatic Fever and 
commonly is Preced'd by a Slight Shivering in 
Proportion to the Degree of Inflamation; this is the 
common and the most frequent appearance of the 
Phlegmon; but it may from many Circumstances
put on a Variety of Appearances; the Seats of this 
Disease or Tumour is in the Dela Cellulora, or the 
Membrane expanded over or between the Muscles,
for Lubricity, and the Membrana Adiposa, the
former is [illegible] then suppurated; and the 
latter is Partial; so it arises from Obstructing
the Fluids Secret'd by that Membranes, for the 
Lubricity of the Muscles, which it Covers. This
Obstruction Continuing Produces an Induration
which on the Consequence of an Inflamation and 
Suppurating the Phlegmon on Account of the 
Method of Cure is Divid'd to Two Kinds. for were
it is not be Caused by one Previous Disease of the 
Habit, secondly where it is the Normal Termination
of some Disordh of the Habit in general; As for 

Instance the Crisis of a Fever. In the first Place the 
Discussion of the Tumour; should be attempt'd by the 
Antiphlogistic Regimen Emollient Cataplasms and 
gentle Evacuations by the Lancett, and Lenient Purges
and Diluting Medicines; In the Second Place We
ought to Make [cross out] Use of every Method in Our Power; in
Order therefore to Carry of the Disease; for this Effort
of Nature might Prove Dangerous or even fatal, and 
Discussion is to be attempt'd by Means so well and 
generally known, that it would be needless here to Point
it out the same may be Paid wth. regard to be the Methods
to Promote Suppuration, when the Matter is Completely
form'd in the Tumour, thus because the swelling could
not be Dispers'd or because it was thought proper to 
Promote Suppuration, it is undoubtedly to be 
Let out, but the Manner in which this should be done
has been a Matter of most Controversy. Our
Forefathers did it by either Omission or by a Caustic
the latter was more generally Us'd, because by this 
Means the Matter was more Effectually Let out of 
the Abscess; on the Account of the Opening they made
but in this they do not seem to have any great 
Regard to the Pain Occasiond be, this Application

of the Caustic and the Indelible Sear Necessarily
Left behind; when they open'd by the Knife it was 
Customary to Cram the Sore with Lint, afterwards [cross out]
Using not Medicines as they thought Promoted
Suppuration, [illegible] the Contrary when not at all
Calculated for it, by this Means the sore was Surround'd
for a Considerable Space with Inflamation, therefore 
what Contribut'd to the Opening greatly of the Abscess
by Caustic was that there who made use of the 
Knife did by their Erroneous treatment of the Sore 
afterwards; and this then brings their Method into 
Contempt and Disrepute; Incision is much the best
and what I would Recommend to You. This either
making a Puncture or a large Opening wth. a Stroke
of the Knife will Answer the End, You Arrivd at
which is only to Evacuate the Containd Matter, and 
this will always be found the most Useful and Beneficia
to the Surgeon or the Patient they thought that 
the Cavities of [illegible] [illegible] made by the 
Destructing and therefore they thought that they 
where to fill it up again with Flesh and Us'd such

Medicines as they Call'd Suppuratives and
Digestives to Promote this End; the Method Brought on
all those Evils which they Want'd to Avoid. The 
Use of the Caustic they Imagind was a Specific and 
after Leaving the Eucher to Slough off they form'd
the Cavities filled up, and therefore without Considering
the true Reason they Preferd the Caustic, for when the 
Application of Caustic was Us'd they never fill'd the 
Cavity with their Suppurative Medicines Lint &c. He 
is well Known that Matter is Form'd by the Melting Down 
of some Membranous Parts, but this Been a very
small Proportion indeed to the Quantity Form'd of Matter
and Nature herself as soon as the Matter is Let out to 
Contract the Cavity. And We only are to take Care of the 
general Health, and to Maintain such a Opening
as to Present a Judgement of Matter; for the Sear of the 
Matter is often out of the Beast of Our Dressings
and Yet Nature Comes through Abscess as herself. Then
this We find from the filling up the Cavities of Abscesses
with Lint and the Escharotic Dressings was truely
wrong and Prejudicial. And that soon if we where not to 
Apply any Thing the Cavity will be Contract'd.

And upon the whole, We may Allow that the 
Application of a Caustic is hardly even to be Us'd; In
[illegible] simple Phlegmon, the fever generally, Ceases
on the Formation of Matter, but as this do's not always
happen the Assistance of Physic is Necessary; Inflamation
do's not always Terminate in [cross out] either of these two Ways
but sometimes End in Gangrene and Mortification, this 
is generally attend'd wth a Disease of the whole System
when the Habit is Mended and the Gangrene Superficial
Nature herself will Throw it off but when the Part
is entirely Speculated it requires Changes to get 
rid of it, when the Gangrene Succeeds great Pain
and fever &c then We are able to Say the Gangrene
has spread more Internally than what appears 
externally, and if the Operation of Amputation must
be Perform'd higher than the Part Gangrened; and 
the Part Mortified Separates Considerably
above the Discolouration, and is Discharg'd into 
the Cellular Membrane, and always up above
the Mortification. The Operation must not be Stop'd 
before the Mortified Part begins to Separate
for the Mortification can never be Stop'd by an [illegible]
We should above; Attend to the Patients general 

Habit and Counteract such Symptoms as shall at 
the Time Occur, either by Evacuations or the Contrary
and if there is a fair separation Obtaind in 
Consequence of a fair Suppuration Establish'd
this will Point to us the Place where we shoud
Amputate and We should always Wait for this 
not Amputate (as was the Custom of our 
Forefathers, at the Place above for the Reason
of having a good Stump for the additional 
Pain and Consequent Inflamation is very likely
Mortification apart and will often Infallibly
Destroy the Patient; Scarification is thought
to be little more than Scratching the Skin, but 
Gives Pain to no Purpose) If it is meant
to make large and deep Incisions it may 
possiby Discharge a Putrid Lanias and 
Unload the Limb. but it is not Known that
Produces any Sensible Effect. The Erisapelas is 
suppos'd to be Produc'd by Bile it is formd in 
Bilious People and it requires a different 
Treatment from the Phlegmonous. it is commonly
flat and Broad and spreads to a Considerable 
Distance and has not the Scarlet appearance of the 

Phlegmanous and is not so elevat'd or Point'd and 
is generally attend'd with Vesications when large it is 
generally a Disease of the Habit, this Inflamation
may Proceed from Two Causes (viz) either from
too small a Secretion of the Bile, as too great
a Distribution of it, the Causes which may be 
Productive of the Secretion being Imped'd, or 
from an excess of Drinking of Spirituous Liquors
and Debauches of Various Kinds which are the 
Consequence of an Indurat'd Liver for from 
a Salivation, or from a Weakness of the Parts from 
Disease. The Tumour is generally of a Paler
Colour tinged wth a yellow Cast. The Method of 
treating this Disease is to Strengthen the Patient
wth. Cordials Stomachics Medicines Join'd wth. Chalyts
in Order for to Remove the Obstruction and 
to Promote Secretion of Bile, On the Contrary
you must Promote the Suppuration. The other
Kind Arising from an overflowing of the Bile into 
the Stomach Duodenum and Jejunum and is of 
a more yellow Colour. It is generally Accompanied
wth. a fever, there is thirst Amnesty and Nausea
and Inclination for to Vomit and a dislike to food &c.

Neither Dissolves or tends to Suppuration We should
be Careful of the Means Us'd to Dissolve it, when a 
Disease of the Habit, We should Endeavour to Divert
the Bile by Lenient Purges Calculat'd for that 
Purpose, and also to be Careful in Evacuating, wch.
shoud be Done wth. great [illegible]; for it may be translatd
from the external to the Internal Parts, and We ought 
also to attend to the Natural Strength and Pulse
of the Patient, and take Care not to Impede the 
Circulation already began this Method of by
Discussion for ought never to [illegible]
and we are to Promote suppuration when Nature
Seems Inclin'd for to Produce Matter, it is always
to be Encourag'd, there is no method of Discharging
the Matter but by a proper opening of the Matter is not 
then Collect'd in that Circumscrib'd Manner, as in
the Phlegmonous but is left [illegible] in more Places
and the White Cellular Membrane, in a Diseas'd
State and Sloughy two or three or more if necessary 
sometimes the Strength of the Patient is renderd that 
when the Sloughs are separated the Sore has not a 
good appearance. Means the Habit by proper
Medicines and Diet will in good Time enable
Nature to make a Perfect Cure. The Œdematous Tumour

Tumour arises from the Pituitous State of the 
Blood and Juices generally Seat'd in the feet
and Leg's, they are sometimes seat'd in the 
Legs wch. have been Broke, and is Proceeds likew
from an Obstruction in the Absorbant Vessels,
from the Situation of the Leg not being able 
to Perform it Office from time from the Use
of it the Vessels will Receive Elasticity and 
Perform their office, but if it do's not Disappea
the Advice of a Physician is necessary to Remit
the strength of the Patient. The Bark and either
Cordial Medicines Join'd wth. the Chalybeates will be 
found most hope, the Schirrous Tumours. The
Ancient Us'd for to Receive all Indurated Tumours
under this Head but [In?delemus] give that name
taken but that will not admit of Suppuration
by any Means whatev'r; And may justly be Calld
Schirrous or Cancerous, for they are liable to be 
unstated into Cancerous by any slight accident
or a Blow or a Fall, or even the Disposition
or Distraction of a Persons Habit, there are two
Methods Prepar'd for the Removal Extirpation
and Disfaction, the Ancients Recommend'd the 
Caustic as a certain Cure. Duct for my Part

I recommend and Prefer the Knife as I have before done
to your Use; the former is certainly Provid'd you are 
certain of in doing it Business Effectualy, a very
Excruciating Painful Remedy; not let the Patient
who are afflict'd would much sooner suffer the Pain
than Labour to the operation by the Knife and 
Arguments Us'd to Persuade them of the difference
wth regard to the Pain, and the Time of Respiration
is frequently fruitless; the Knife to the Surgeon
who dos [cross out] Know how to Use it, and the Parts he 
is to Cut on, most certainly is Preferable, who 
can Extirpate what he see's is Necessary, and Leave
which is a principal thing as much Skin or will
Collapse and Heal, and having Left but the Remains
of small scar, whereas the Caustic is Productive
of much Pain it totally Darkens the Skin, and what 
is Worse its very apt to doe more in Spite of all
your Efforts to the Contrary; We intend'd to have mentiond or ought
to have done their never has been found was
any Internal Remedy for the Relief of those Tumours
the only one is this Propos'd.----

Lecture 2d. On Wounds
Wounds are by the old Writers Distinguish
into four different Kinds, Incision; Laceration, 
Puncture; and Contusion but in Order to Give you
a more Clear the Idea of them I should Describe
them under the following needs.
Just those which are necessarily Mortal
2d. those which are not in Themselves.- 
Neither Mortal nor hazard one but by Neglect
becomes so; of the first, then are Wounds on the Lungs Near 
Cerebrum, and Medulla Oblongata, Aorta Vena,
Cava Receptaculum Chylic, abd Ductus [Thoracic??]
Those of the Second are the Liver Stomach,
Pancreas and Mesentery, the Spleen and Kidneys,
Those of the Kind Inclind to all Slight Wounds Inflicted
in any Part of the Body; the Method of treatment
and Symptoms attending [cross out] those several Kinds of 
Wounds; of Wound shall omitt until I hear of then
Distinctlly, recent Insis'd Wounds, our first 
Intention must be to Procure a Union of the Divd'd Lips
of the Wounds' I have heard by different Writers
on this Subject several Methods Propos'd and likewise
different Sutures a Description of which you
may see in Kaister and other Authors; the 

Interrupt'd or the Common Suture in those slight
Wounds is the best, Not but the Day one may
sometimes be Judiciously Us'd, as in the Jaw and 
others Parts which are Expos'd, Deformity should be 
Avoid'd: We are Advis'd by French Writers before We
bring the Lips together in Order to Constringe the 
Vessels to Apply a little Allum finely Pulveriz'd or any
other Astringent Powders, but this Method will
certainly Irritate their Intention, by Acquiring a
Suppuration to Cast off the Gramous Blood Clott'd
together by means of the Application, and rendering
the Wound from Healing by the first Intention, which it 
certainly will doe if You Procure the following
Method, after having Examin'd the Wound, and 
found [cross out] of there by any extraneous Bodies, as Dirt &c, which
may have Accidentaly get in to it. You are to
bring the Lips of Wound in to Contact; and in
that Position You are to make Your Suture, and 
Cover it with a Pledget; It is the best Way to make 
a Slip Knot, as You may by that means easily
Remove it, but it sometimes happens from the 
Patient Jandancy to Irritation and Inflamation
that [cross out] these Slight Wounds will be attend'd
wth. much Pain, and Inflamation and some
Degree of fever; [cross out] wch. will require some Attention; 

Our principal Endeavours must be to abate
such Symptoms by Phlebotomy, Lenient
Purges, Opiates, Saline Draught, diluting
Liquids and the Like; and likewise the proper
Position of the Limb or Part of the Body Wound'd.
The Prevailing Practice of London Seems to 
Deny the Use of Sutures thinking them that of Useless
and Painfull Methods; but I do differ from [illegible]
own Experience, there who Decline the Use of Sutures Lay aside 
every Useful and Advantagous Part of the 
Art.-- In Lacerated Wounds it may sometimes
be and if You are Cautious and Say come mention
the Strength and the Situation of the Wound, for 
tho they certainly differ from Incis'd Wounds
yet there are some Inflicted Rarely resembling
them; the same Method is to be Pursued, those
Wounds are generally Attend'd wh agrees Degree
of Inflamation; and such Regime greater
Attention, where in large Wounds of this Kind, tho
there certainly is a less Substance whereby the 
Intention by Means of the suture is Frustrated
yet are of Use in Contracting the size of the Wound,
and in some Degree hasten the Cure; If the 

Wound will not Heal from the Loss of Substance
by this Method, [cross out] Consequence Attending
this Method is Trivial, for it will not add to the 
Inflammation, nor retard the Cure; The Suture will
bring the Lips of the Wound more in Contact
and the proper situation; and half of the Bandag's
You will be able sooner to Compleat a Cure. [cross out]
Wounds made by a Puncture are in themselv's inconsiderable
but are Liable to Prove otherways by the Patient
Constitution, the Inflammation, the Symptoms sometimes
Attending them are very Alarming, A Wound Inflicted
on the tendon of the Biceps Muscle, or any other
We frequently find, is Attend'd with much Pain
Inflammation and Rigidity of the Limb from the
Carelessness of the Patient, and from a strong
Position of the Limb, the Surgeon is to Inquire
how and by what Instrument, it was Inflict'd; And
then Proceed to the Patients Relief; if the Part which
is Affect'd be much Swell'd, and Inflam'd and 
attend'd with some Degree of fever and Pain
keeping the Body Open, the Exhibition of Saline
Draughts and Plenty of Diluting Liquors, VS.
Placing the Limb in a Balanc'd Position and [Apply??]
Emollient Cataplasms should be Continued until 

the Symptoms Abate, but after all these Attempts
Us'd the Symptoms instead of Decreasing Increase
and the Limb threatening a Mortification, the 
Use of the Bark Join'd wth. Cordial Volatile Medicines
Antiseptic Fomentations, Cataplasms are to be 
applied to the Part We may by Rare Means Hope
for Releif, but the Disease still Continuing the 
only Resume will be to Remove the Limb.
Of Contus'd Wounds, Those Call'd Gun Shot Wounds are
the most Violent, and under this Head it was the 
Prevailing Opinion, that no Person who had
not been Abroad, And Attend'd Wounds of this Nature
ought not to Presume and indeed were Deem'd 
Incapable of giving any Releif to the 
Patient; the Ancients Support'd that the 
Powder and the Materials wth. which the Wound
was Inflict'd Carried with them a Poisonous
Quality; from this Erroneous Positions, and being
Influenc'd by this Opinion they Treat'd the 
Patient directly Contrary to the Method I shall
Relate in Order to Guard against the Poisonous
Body they Administerd high Cordial [illegible]
Medicines and Aromatic Fomentations by which 

Means they encreased every Symptom of the fever,
Tension and Inflamation, The Practise I make Use
off in the Cure of these Kinds afterwards in the 
following, having Inquir'd wth. what Kind of fire Arms
they were Wound'd or the Wound Inflict'd, and in what 
Position the Patient was in at the time, and likewise
what the Peice was Load'd wth. You are then Carefully
to Extract the extraneous Bodies there in Lodg'd
but in these Wounds tho they have admitt'd
a Bullett, the Muscular fibres from the Irritation
it Causes generally a Contraction, and You will
Scarce be Able to see the Parts were it Enter'd.
In this Case it will be proper to enlarge the Wound,
if the Part will Permit, which You will be able
to Judge from its Situation, and with the Help
of a Pair of Forceps Extract it; but it happens sometimes
that it Enters so Violently, that it may by making 
an opening be much sooner and easier Extracted
on the Contrary Side almost through the Limb; having
Cleaned it as much as Possible the next thing
Propos'd is Dressing, which must be very Softend
Lenient; and entirely freed from any Irritating
Quality, the Digestion, the Balsam of Bartholomeus
Hospital Applied to the Wound and Covered
with some Warm and Relaxing Cataplasm
will Prove.-- 

Serviceable, and must be Continued some time; there
must be also some Attention Paid to the Inflammation
which must be by, Bleeding largely, Glysters
Given Occasionaly, with Plenty of Diluting Liquors,
Observing a Low Regimen, and not forgetting
Opiates to Appear the Pain; after a Plentiful
Suppuration Comes on, The Bark may be 
Prescrib'd wth. Success. If any of the Vessels
should be Divid'd You must first take Care to Secure them
by a Ligature before You Attempt any 
Application, a great deal has been Said
Concerning the Method of Stopping Hemorrhages
there has been Four Methods Prepar'd (Viz) by Pressure
Stypticks of Various Kinds, the Needles, and 
Ligatures, and by the Cautery, in some 
Cases Pressure may doe very well and 
certainly do's when it is gently Us'd, but 
it is too often apt to Occasion Mortification
by a too Strong and Continued a Pressure;
Styptics may sometimes be of Service, those 
of the Escharotic or Corrosive Kind are Prejudicial
and ought never to be Us'd in small Bleedings
I have made a tincture of Gall Nuts in the 

Rectified Spirits of Wine, and Balsam Fraumat
which has been very Efficacious; the Needles and Ligatures
are by far the best, and inert Method; and what 
I would Recommend to Your Practise, always
take up the Vessels as Naked as you can. And
never Include the surrounding Cellular Membrane
for as that begins to Suppurate, the Ligature
becomes Loose, the Artery will again Dilate and 
You will have a fast Hemorrhage [cross out], which will
now perhaps be very difficult to stop. As by the 
Last Method by the Cautery it is too extremely
Painful and highly [cross out] Unnecessary, and that is 
now Universally Explod'd. 

Lecture 3.
On Fractures
Fractures are by Surgeons both Ancient and Modern
Divid'd into two Kinds', Simple and Compound; what
is Meant by the Simple Fractures is when there 
is a Division of one or more of Bone or Bones,
without any external Wound; And a Compound
Fracture is a Division of Bones, and a Wound
Occasioned by the Protrusion of the End of 
such Fractured Bones; I shall in this Lecture
only treat of Simple Fractures. A Simple
Fracture may be Caused by Various Accidents
as Falls Blows, and which by proper
treatment and Care may easily be Reduced
and Cured; Our Predecessors where of Opinion
that Broken Bones coud not be properly
Reduc'd unless an Extension was made, that would
force the Resisting Muscles, and bring the Ends
of it in a Straight Line, but seperate but afterwards
Suffer'd it to Come into Contact by gradually Relaxing 
the Muscles, this was their general Opinion and 
as such Put in Practise. After having by Extension

and Counter Extension having Plac'd the Ends of the 
Bones in Contact, the Assistants who are Direct'd to keep
it in that the Extend'd Situation, till the Bandage
Plaisters and other Necessary Applications where made;
the Surgeon then having Felt the Ends of the Fracture
wth. one Hand, and gradually applying an Adhesive
Plaister wth. the other, which they thought woud
Act as a Discutient. Next to this they Us'd to 
Apply the Circular Bandage, and to that where 
Plac'd Four Splints, which where made very 
short, to Answer the Purpose as they thought of 
keeping the Ends of the Bone even, and in Contact
and Lastly after every Kind of Compress, a Banadge
as they thought Necessary for the Security of the 
Limb was Applied, and it was rest'd in this Extend'd
Position in a Fracture Bone, made of Wood whose
bottom Lies in a direct Plain. wth. sides to Prevent
the Clothes from Pressing it. As I have Now given 
You a Description of Our Forefathers Practise,
and which I am Sorry to Say it, is still Continued
by some. I shall take the Liberty of Relating 
it to You, the most Safe and Effectual Method
of Reducing and of treating Fractures whether
of the Leg or thigh. Having Put Your Patient 

to Bed and Prepared Your Apparatus which 
are a Pillow and Eighteen taild Bandages a Flir
of Plaister Tapes and Cradle; You are to Place
the Leg so as to have it in a Balanc'd Position
upon the Pillow; and if from Placing it thus the 
Ends of the Bones are not in Contact, which 
generally You may wth. very little Extension
Replace them, this done You are to Apply Your
Plaister on it, the Bandage, and treat the Splints,
which must be only two in Number, and Long
enough to Serve both Joints, which is the Intention
Meant by them; these are to be Lined with [??w] or 
any other Soft Substance, to hinder the Pressure 
on the internal Malleolus or external Condyle
then Secure the Limb in the Pillow by tapes
around to Place over it to Prevent the Pressure
of the Bed Clothes Your Cradle. It will be 
proper to Bleed Your Patient and if Costive
Order him a a Glyster, the Advantage Arising
from this Kind of Treatment is Obvious;
Placing it in a Relax'd Position certainly
Prevents Tension, and Inflamation; and the 
Muscles are thereby hinderd from Acting. The
Plaister which should be applied shoud be of the 

Repellant Kind, much as the Carat Sapon of
Bartholomews Hospital or the Application of the 
White of Egg's and Acct. Spirits of Wine alone or 
Mined wth. Vinegar and Spiritus Minder; all these
are very proper and much more so than the Applications
they Us'd, which where Exp. Robor; Piris; which are apt
to bring are a Necpes and Cause Violent Itching.
The Bandages he recommends are certainly
very advantageous, As it do's not require the 
Disturbance of the the Limb, which the Roller
do's and must Impede the Formation of Callous,
And this Position of the Limb will Admit of the 
Applying of Cataplasms, full as well as the 
other. The Splints are Mentioned before, and must 
be large enough to Secure and keep Steady
both Joints, and may be fasten'd in the Manner
Propos'd; and You must likewise Pay some
little Attention to the Situation of the foot.
Taking Care sufficiently to keep the Bone Level.
This Method strictly Observ'd will have the 
Desird Effect.---  

Lecture 4th.
On Fractures Continued.
Having in some Method Describ'd to You the treatment
of Simple Fractures and the Applications proper
to be Us'd. I shall now relate a few particulars
on each Bone. If the Clavicle be Fractur'd We
are Ordered by our Ancestors to make a sufficient
Compress on the rising Ends of the Bones so as to 
Depress it, and bring the rising Ends of the Bone in 
Contact wth. the Inferior End. but this Doctrine
is Absur'd, Erroneous, and Impracticable; for 
were You to Press ever so great a Weight upon
it, You might Crush the Bone; but would never
answer Your Intention. in Depressing it.
The Clavicle is fix'd to the Sternum and Scapula
by a Ligamentous. Articulation for keeping
at a proper; Distance the Scapula from
the Body; thus when Fractur'd it is always 
Depressed at the End Articulat'd to the 
Scapula from the Weight of the Stone falling
inwards its evident that the former Practise
is Erroneous, and that which they form the 
Chiding End is truely on its Place the 

the only Method of bringing the two Ends into Contact
is to Elevate the Arm until You find the surface of 
the Bone even, then to Apply a Plaister of [illegible]. Supor
wth a small Compress of tow, Securing it by a 
Bandage wch. is to Crop the Bark and Breast
in such a Manner as to keep the Shoulders Back
and Breast as much as can be allow'd of for the case of Your
Patient not forgetting to keep your Patient arm
Elevat'd without which Your other Applications
are fruitless. In the Inactiv'd Tumours; for the 
Reduction of which You are to Relax the Muscle
of the fore Arm, or they will Prevent the Antagonist
and translate your the Intentions, tho You should
Use great Extension, to bring the Ends of the Bone
in Contact; the Method of Reducing it is this 
is to Bend the Arm Setting the Patients Palm
of his Hand be on the Breast. And then if Requir'd
make Your Extension, then Applying Your Cerate
and Bandage either the Eighteen Tailed or Circular
keeping the Arm in the same Position. In a Fracture
of the Arm or, of the fore Arm either of the Ulnar the 
Radius, We are to Consider that We have not
only the Muscles which Perform Flexion and 
Extension, but Pronation and Supination,

and therefore the Arm must be so Situat'd as 
to give these Muscles no Cause to act, having
Relax'd the Muscles by Placing it on the 
Patients' Side, and Rending; You are to
Remember) to place the Patients Radius
upwards, to Place the Palm of the Hand to 
the Patients Breast. and make whole extension
may be Required. after that Apply Your Cerate
Bandage and Splints, Placing it in a Pillow
Secur'd by a Sling in Order to keep the Arm in 
the Direct'd Position. In the Fractur'd Femur
having Put Your Patient to Bed, and Plac'd
him in an easy Position on the Side which
the Fracture is, You are than by Relaxing the 
Muscles of the Leg, to Lay it in an Oblique
Position, And in that Manner make Your
Extension, having got at the End of the Bone
in Contact, You are to Apply Your Bandage
and taking Care to Place the Knee in such
an Elevated Position, as will keep them
in Contact. For a Fracturd Tiberias Tibula
the Leg is to be Plac'd in the same Relax'd
Position, as is above Mentioned. But it sometime
happens there will be a Fracture of the Tibula

wth a Dislocation of the Tibia. which is a Case which
her Perplex'd Our Ancestors much. And by their ill
Treatment made them liable to very Disagreeable
Consequences. Having [cross out] Seen several wth.
very Alarming Symptoms, they Us'd to Place
the Limb in an Extend'd Position, and as they Laid 
Reduce the Dislocation, by making a most Violent
Extension, which was the Practise and wch. is ever to be Condemned,
all that is to be done in this Case is to Lay the 
Limb in such a Position as for a Fractured
Leg, by that Means You Relax the Muscles
and Ligaments Surrounding the Joints, and 
in a great Measure Replace the Mallastus 
Internus which was thrown outward. In this Case
the Tibia is thrown off the Astragalus and the 
Ligaments are Lacerated; but by this 
Method, And Attending to the Symptoms
and Positions, You may Promise Yourself
a Happy Cure. There are Two Fractures in 
the Human Body which Require the Limb 
to be Placed in an forehand'd Position, which 
are these a fracture of the Olcranon and 
the Patella, the Position keeping the Ends
more in Contact, than in a Relax'd or Bent one
[illegible] than Extend'd either the Arm or Leg 

You are to Apply Your Cerate, and Circular
Bandage, Keeping Your Patient at Rest. It
sometimes happens but from what I know 
not or cannot Determine whether its either from too small
a Quantity of the Ossifying Matters or the 
Patients Constitution, that after the Patient
has Kept his Bed for Six Weeks or Two
Months, that the Bone will not be firmd
have Seen this Twice or Thrice in the Os
of the Humeri more in that Bone than in 
any other in the Body. If this should happen
the Method I should advise, and which I have 
found most Useful /is this/ to Let the 
Limb Hang in a Depending Posture for about
the space of an Hour, and to Mind the 
Patients Habit by the ordering of Cost Peruv.
The Relax'd one or Two Cases when the Callus
in a Carinate Patient Produc'd a Caries of the 
Bone, and Loss of the Limb, and when the 
Limb was Remov'd the Cancerous Veins
Attack'd the Viscera, and the Patient Died.
In all Fractures there is a Symptomatic
Fever more or less and some Degree of Tension
according to the Habit of the Patient; You
are to Attend to those Symptoms, and Obviate them

by such Evacuations as You shall Judge necessary
in Pletheric People, You will sometimes have 
a Violent Tension, and Inflamation; and in
Gouty Patients, very often a Violent F.H. which
is a very Disagreeable Circumstance. In all these
Concomitant Symptoms You must Pay the 
Utmost Attention, and make Use of such means
as will be most Productive of Your Patients
Safety, And Your own Reputation. In the
first the Antiphlogistic Regimen will Answer
Your Intentions; In the Second Medicines
and Fomentations Calculat'd for such Disorders
and to Divert the Symptoms attending it.

Lecture 5th.
On Compound Fractures
A Compound Fracture is Produc'd by the Protrusion
of the End of the Broken Bone, through the 
Integuments Covering it, Causing a Wound, whether
large or Small, I shall first treat of one which Requires
very Judicious Treatment, which every honest Man
would Exert his Judgement to Know whether such a 
Limb is Capable of being Sav'd without hazarding the 
Patients Life. In a Fracture, where the Bones are
Broken very Obliquely and at the same Time Protrudes
so as far as to Put it out the Surgeons Power
to Reduce it. Join'd at the same time with a 
Violent Laceration of the Parts; in such a Case
undoubtedly the Operation will be Necessary.
It is impossible for the most Experienced 
Practitioner to Determine whether such a Limb
may not be, but it is certainly most Prudent
to Remove the Limb, in these Circumstances
You run a Hazard of Your Patients Life, for 
in this Case there is no time to be Lost, from the 
Circumstances of the Case must be Urgent.
The Symptomatic Fever must be great and an 

Impediment to the Circulation must be the Consequence
from the Laceration. The Second Case is when the Bones bear
much Crushed or Broken and the Surrounding Parts
so much Build by the Weight, as to Put an End
to the Circulation; this as well as the other will Require
the Operation. The third Case which will Require
the Operation, in having Attempted to Save the Limb.
The Inflamation Notwithstanding You have made Use
of every proper Method, so as to bring on a Gangrene
and then Mortification. Remember this Circumstance
that if You have not Removed the Limb before the 
Mortification has began to Spread; and that Removing
while Spread it will Destroy the Patient, as it will
by no Means a Stop the Putrid Virus, therefore
it behoves every Person to Assist Nature, by such 
Means as will Cause a Separation of the Diseas'd
Parts. The Symptoms Arising on the first Case
are. If the Limb is not Remov'd in a very short
Space of Time, Violent Symptomatic Fever Attend'd
wth. thirst a Parch'd Brown Tongue, and very frequently
a Diarrhea. The Limb at the same Time in an 
Inflammatory State, these symptoms may Continue
two or three Days and then instead of Inflamation
the Limb will Put on a speculated] Appearance 

the Fever is then increased and Attend'd with 
a Singulous and with a Delirium, and frequently
Fetid Stools and wth. Colliquative Sweats, and Death
inevitably the Consequence, An Instance of this Kind
I lately Saw in the Hospital. Where the Tibia
and Fibula where much Broken and the former
Protrud'd, and so much as made it Impossible to 
Reduce it Mr Pitt advis'd the Man to Submit to the 
Operation, but he absolutely Refusing at the 
End of four Days he Died, in the above
Described Symptoms, frequent Bleeding was 
made Use off. and likewise Lenient Purges and 
Glysters so as to keep the Body Open and 
and Abate the the Inflamation; the Bark was 
Administer'd, [cross out] when the Limb Put on the 
Sphacelat'd Apperance. The Volatile juleps
was Join'd wth. it. The Limb was Foment'd with
the Aromatic Fomentation, And a Poultice of 
Wine Les was Applied and Oatmeal. The 
Symptom from the Second will be the same but 
whether they will be so evident soon, I cannot 
Say; but it is very Evident that a Limb
Join'd and Bruised in such a Manner will not 

Admit of the Reunion of the Pieces of Bone, nor 
can We ever Expect the Circulation to be Carried on,
If not the Hemegnance must be from Gangrene and End 
in Mortification, which will have its Concomitant
Symptom's and Destroy the Patient as in the 
preceeding Case, the Method Us'd must be the 
same. And if the Pain is Violent in either Case Opium
must be Employ'd and wth. Success. In the 
Third Case when the Limb has gone on for some Time 
favorably by the Methods which have been
Us'd, it will sometimes happen from the 
Natural Tendency of the Patients Habit, that the 
Inflammatory Symptoms will Return wth more 
Violence than at the first, and all future Attention
will Prove Fruitless. Its still increasing the Limb Put
on a Gangrenous, Appearance, and at Length
Mortification; then it will be Necessary to Assist
Nature in Separating the Morbid Part from the 
Sound Parts, by the free Use of the Cortex, Join'd wth. Aromatic
Medicines; If You can by this Means so far keep up
the Vis Vitae, so as to Cast off the Morbid Parts, and find
You have Stop'd in Progress, than the Operation
will be Necessary on that Part of the Limb it is to 
to be made, the situation of the Parts will Determine 

having treatd on those Fractures which will Require
these Operation shall Relax a few Particulars
on those Symptoms which are more Lenient
We will Suppose a Compound Fracture Caus's 
a small Protrusion of the Ends of the Bone,
And Attend'd which is sometimes the Case wth.
a great Degree of Tension, and Inflamation; all
that is Requir'd is to apply a Pledgit of Cerate,
and the same apparatus as in the Simple
Fractures, but sometimes it happens that the 
same Case, shall be attend'd wth. a great Degree of 
Tension, and Inflamation and Pain, than it will
Require You to Attend Strictly to the Symptoms
and Alleviate them, by such Means as will
Avoid Matter Forming, and hindering the Wound from 
bleeding by the first Intention; To Accomplish this,
Bleeding, the Application of Emolliment Cataplasms;
And if that do's not Answer Your Intention a Weak
Solution of Sal Ammoniac will be proper
likewise Spiritus Minder. Vini Vingear, may
be Applied in the [cross out] [illegible] Cataplasm or after
it has been than Us'd; [cross out] the Inflamation shoud
increase and some Degree of Symptomatic Fever
Attend him repeat'd Bleeding will be proper

If the Pulse will Admit of it, Not Omitting Saline
and Nitrous Medicines. If nevertheless Matter shou'd
be form'd it will be Necessary to Assist Nature, by an 
Emollient Cataplasm, And when a Sufficient Suppuration
in Produc'd to make an Opening in the most Depending 
Part of the Limb; In large Wounds of the Joints, when the 
Capsular Ligaments are Wound'd and a great
Quantity of Synovia is Discharg'd, the Consequences
are generally Inflamation and Gangrene, which render
the Operation Necessary-----

Lecture 6th.
On Luxations
Luxations are Caus'd by Various Accidents, and the 
Knowledge of the Part is Requir'd to be well Understood
in Order for to Qualify a Person to Reduce them.
In Order for to Know this I would Advise You to
Direct the different articulations of the Body
and Pay great Attendance to the thin Ligaments
and Cartilaginous Appendag's there to be longing.
If You are to Remove the Muscles Surrounding the 
Joints the Barral Ligaments woul'd be Joined
in some Incapable of Supporting it in its 
proper Situation, therefore the Origin and Insertion
of the Muscles ought to be Known, and Understood
without which it will be Impossible to Reduce
it wth. ease to Your Patients and Satisfaction
to Yourself. for the Relaxation of the Muscles is 
of Infinite Service in the Reduction.
The Os Humeri may be Dislocated either Inward
Laterally or Downward. it sometimes happens
that the Head of the Bone is thrown under the 
Pectoral Muscle, in the Reduction in this Case
instead of Extending the Arm, and bringing it 

from the Body, You are to keep it near the side and 
Relax the Muscles by Banding the Fore Arm, by that
Means making so great an Extension, as well
bring the Head of the Bone more forward on the Edge
of the Cup and then give Way, and by the least
Elevation of the Bystanders it will immediately
goe into its Place. If the Accident has happen'd
that the Method a Practitioner is able to make the 
off wth. the Hands will not Succeed. I would
Advise you always to Apply Your Towels, or what
ever else You Intend to Use for Your Extension
at the lower End of the Bone, keeping the ForeArm 
Bend'd as by this method all Your Force Applied to
that Bone alone, for if You Apply it as some 
Authors Recommend one Towel on the Luxated
Bone and the other on the Joint below the extend'd.
Force, on the lower is Cast on the Ligaments
which Articulate it to the Luxated Bone they 
Yeild to Extension----- 

Lecture 7th.
On Wounds of the Head.
Whoever will give themselves the Trouble to Reflect on
the Structure and Mechanism of the Cranium and its 
Contents, will Necessarily See the Numerous ill
Consequences, Attending Wounds Inflicted on the 
Head and; Scalp Consists of the Cutis, Tela Cellulosa
Muscular Expansion of the Frontal and Occipital 
Muscles within Tendinous Appendanges, and the 
Pericranium which is Expand'd over the whole
Surface of the Cranium, the Vessels of the 
Internal Pass to Pass through to Anastomose 
wth. the External, If You are Examine the Dura Mater
of those who have suffer'd any Violent Death,
You will find a Number of Bloody Points on the 
Surface of this Membrane, which are the Orifices
of Dilat'd Vessels, I need not mention the 
Treatment of a Simple Wound of the Scalp
as every one knows how to Treat it, but 
it sometimes happens that a great Part of the 
Scalp becomes Detach'd so as to hang Down
like a Flap, this may Arise from the Passage

of a Coach Weal over it; from the Appearance these
Wounds make, It has been the Opinion of some 
to remove the Portion of Flesh should be Remov'd, which Practise
Mr Pott Disapproves off. One Object besides many
others, is that when this Separated Portion of Flesh
is Removed the Patient will never have any 
Pain there Consequently the Patient must ever remain
Bald those Circumstances ought to be Consider'd
therefore the general Doctrine, can Stand upon
no other Foundation, than this where the Suture can 
not be Appli'd, It is very Obvious that all 
Extraneous Bodies, as Dirt &c must be Removed.
If a Suppuration, shou'd happen the Scalp
is by no Means to be Removed on this Account
If Matter be form'd You are wth. Your Lancett
to Let it out, I am of Opinion that a Suture
in most Wounds is best, even when the Scalp
is Lacerated, and the Bone Laid Bare, and 
You should never remove the Scalp except
in one Instance, where You have such Symptoms
as Indicate the Application of the Trephine
than Necessary. It sometimes happens that Puncture
the Skin the Tela Cellulosa, the Aponeurotic

Musclar Expansion and the Pericranium wholly
Injur'd. If the Tela Cellulosa be Wound'd or Injur'd it often
happens the Wound. Puts on a Puffy Appearance
and Vesications Containing a Yellow Colour'd Serum,
there are of the Erisepellatous Kind, and their 
Appearance will sometimes happen in 24 Hours
after the Accident, happen'd it; and will appear
in this Case as if it Proceed'd from some Internal
Cause or Injury but it do's not, although this 
Patient will have such a Nausea at his Stomach
and frequent Vomitings, these Kind of Symptoms
happen in Bilious Habits, it must be Treated
after the Manner of an Erisepellatous Disease
Evacuations by Bleeding Lenient Purges
and Anodyne Poultices, will be found Serviceable
these Cases where well Known, Hippocrates
who Warns the Reader to be Careful in not 
Mistaking this Disease by Supposing it greater
than what it realy is on from some Injury done to 
the Internal Parts. It sometimes happens, that where 
the Muscles and their Tendinous Expansions are 
Wounded whether the Tendons have any Degree of 

Sensibility or not, at this Time I shall not Pretend
to Determine however I am of an Opinion that there 
are Nerves Passing into them, therefore they must have some 
Degree of Sensibility; from Injuries of those Parts You
will have a Tumefaction Come on, And in a Sanguineous
Habit Your Patient will sometimes be Delirious.
This Case highly Requires Evacuations and the 
Pulse will be your best Guide; in the Erisepellatous
Appearances Carefully Attending to the Pulse; If
You make too free wth. Evacuations, and bring the
Pulse below Part, will most assuredly You will
Destroy Your Patient, and You will never have it
in Your Power again to Raise it. I have been Eye
Eye Witness of the many Fatal Consequences Arising
from the ill Treatment of the Disease. There is no 
Disease so liable as this to Translation. An
Inflammation on the Pericranium will Cause it
to be Considerably on the Stretch, it behoves
You here to Divide about two Inches Down to 
the Bone, in the Wounds of the Scalp Fomentation
and Cataplasms, will when there is Inflammation
sometimes Relieve When by an Injury done to 

the Integuments of the Head. The Dura Mater by
Inflamtion becomes Separated; from the Internal Surface
of the Cranium. The Indicating Symptoms of such
Injury as Stupor seldom before the 2, 3 or 5 Day
or even 25 Days from Inflamation and Suppuration
takes Place and the Patients rigors becomes
Exasperated, And in this Case nothing but a 
Perforation will doe, Contusions of the scalp must 
be heal'd by the Discutients; And in all Cases
where there is an Extravasation, be very Cautious
in Prognosticating for it will Appear on the 
touch as if there was a Fracture wth. a Depression
but on the Application of Discutient Remedies
the Disease will frequently Disappear.... 

Lecture 8th.
On Injuries of the Dura Mater.
This Disease was well thrown to Hippocrates who has 
particularly heated of it. I mean to treat of this by 
Mentioning the Injuries, that liable to happen to the 
Dura Mater, from any external Violence on the Integuments
which are always to be Seen in those People who
Die Apoplectic or are Hanged, those Prints which are
then Visible are the Extremities of Lacerated Vessels,
The Dura Mater Serves the same Purpose on the internal
Part of Cranium, and is as Closely attach'd as the 
Pericranium is on the External; If You Perforate
the Cranium of those who Die Apoplectic, You 
will find it difficult to Seperate the Bone from the 
Dura Mater, when from a Fall or Blow a mature
Extravastion shoud happen You will find the 
Extravastion Verge in its Hand and Situation
it sometimes is between the Scull and Dura Mater
at other Times between the Scull and Pericranium
Whenever Situat'd the Symptoms are of Various
Kinds from the most Slight Swooning Down to the most
Comatose State sometimes a Loss of Voluntary
Motion, Hemorrhages from the Nose and Ears 

likewise happen. It sometimes so happens
that the Vessels are so Injur'd as to Cut off all 
Communication between the external Vessels and 
Internal Vessels, Consequently the Circulation must
be Imped'd wherever the Injury is. The Consequence
must be Inflamation and the Vessels put on 
a Sloughy Appearance, Extravasation is 
Caus'd by Detachment of the Vessels, the 
Inflamation then next, Comes on, And the 
Sloughy Appearance Follows, and the Separation
Cast off all, and it Looses its adhesion this
is the Consequence of the Inflamation, You
ought to be well acquaint'd wth. the Manner of 
Distinguishing this Disease, Extravasation is 
Produc'd immediately, and is Symptoms of 
Depression simply, Inflamation is a gradual
Symptom and must be Prevented by Art, When
it happens in the Internal Cavity of the Cranium,
You cannot Know it by the Touch, when externally
you may Distinguish it, When Inflamation
Comes and Matter is Form'd, the Dura Mater begins
to Separate itself from the Cranium; the Pericranium
likewise becomes Separated on the external Surface
there is to be found a Bloody Kind of Tonics

between the Bone and Pericranium, there is also
a Puffiness and a Circumscrib'd Tumour on the external
Part to be found. If in Ten or Fifteen Days Your Patient
should have Loss of sight and other Symptoms. If 
upon Opening the Tumour You a Quantity of Same's
and the Surface of the Bone Put on a Dry appearance.
If Bloody You may take it for Granted, and 
Rest well Satisfied there is Mischeiff underneath
the Cranium We shall Divide the Circumstances
Attending these Accidents, into those Distinct Parts,
The first is (Viz) it very often happens the Blow
shall be such as to have any external Appearance
of Injury, The Patient now has Febrile Symptoms
Come on, Symptoms of Tightness as if a Chord
was bound part, round the Head, has Shiverings
Delirium and Spasms becomes Paralytic and Dies,
this Arises from an Injury between the internal
Surface of Skull and Dura Mater, this Case admits
of no Cure but by a Perforation to Let out the 
Matter, when the Extravasation is externally it 
behaves You to Open the Tumour, and Let 
out the Matter, and now We Consider the Injury
as Attend'd by a Wound, the Blow Given shall
Cause a Seperation of the Scalp, and sometimes
Communicate a Shock to the Vessels, You shall 

Digest the Wound and it shall Put on a favourable [Appeara???]
Appearance, but at the space of a certain Time
he Looses his Appetite, and the Symptoms
happen such as Fever &c; the Wound then immediately
Changes its appearances, the Pericranium will
Seperate for a a Distance round, And You may 
be well assured the Dura Mater is seperated also
and mischeiff is is Forming within the Cranium
the 3d. State is when a Blow is Inflicted in such 
a Manner as to Lay the Bone Bare, which is 
sometimes done by the Surgeon, in this Case You
have not that Guide as you had in the former
Case to goes by, but when the Dura Mater is Injured
You will have the Edges of the Wound all round
the Surface separated, the Bone will Look Dry
and Yellow, when such an Alteration has this 
happens be Attentive to the Symptoms. In all
these Diseas's the greatest Chance is taking it early
by Bleeding frequently, You will have Inflamation
Suppuration Delirium and Spasms, When such
Symptoms happen as Lead You to Judge there
is Mischeiff internally; You must not Wait
but when the Circumscrib'd Tumour wth. its Usual
Puffiness and Detachment happens You shoud then

Perforate the Bone, for if You Wait the Rigors/ the 
usual Attendant on this Disease will Come on, You will
by no Means Give Your Patient a Chance that he would
have had, if You had Perforated the Bone sooner
this is a a Matter of Serious Consideration also to be
Careful that the Disease Exists. If You doe it in
the early State, One Perforation may perhaps doe in 
the middle sometimes two or more are Necessary....

Lecture 9th.
Fracture of the Cranium.
Fractures of the Cranium may be Divid'd into two
Species the first in simple when the Bone remains
even; the Second when there is a Treatment wth. Depression
The Symptoms are Said to be frequent Vomiting a Stupor
and Loss of Blood, from the Nose and Ears, but remember
You are by no means to Rely on those Symptoms
for they may happen Independant of Fracture, and 
when they doe happen they doe not Arise from the 
Solutio Continui of the Bone, they Arise from the 
Concussion of the Brain, or from Extravasation
Seat'd in the internal or external Part of the Cranium
As my Intentions are to Set You Right, I can not
Help repeating what I have already Observ'd, in 
the Preceeding Lectur's without You recollect what 
I have Mentioned. You will be Yourselves at a great
Loss in My Following on's. In the Common Method
of Heaing the Fractured Cranium it is right 
to Perforate the Bone, and there be no Solutio
Continui As other, Purposes are Saved thereby
there are those Causes for Perforation two of which 
are Matters of Necessity; the Head is a Matter of Elation

or Choice, and this is Call'd the Preventitive Kind
of Remedy, the two former from the Consequence of 
Necessity, As when You have Reason to Suppose there 
is a Fluid seat'd in the internall Part of the Skull
it then becomes a Matter of Necessity, the Symptoms
are Caus'd by Violence done to the Vessels or Membranes
and by Fracture, the Performing the Operation
by Way of a Preventitive has Caus'd great Disputes
among Writers, there has been some few Instances
where Fractures have done well without Perforating
but this seldom happens, that was You to Compare
them you would not find an equal Proporation, between
those when it has been Perform'd, and those to
whom it was not, but sure no Man would goe to
Perform an Operation without an Absolute Necessity
The Consequence Arising in the early State from 
Fracture a Extra Inflamation, and in the latter
Suppuration, and if You Compare the Number
of those which Survive when the operation is 
Performed in the former State wth. those who
Perish in the Latter You will find an amazing
Difference, I doe this to this to Show You the 
Absolute Necessity there is in Perforating the Bone
Considering the Number in both Hands, to these 
Cases I shall, add another; In Case of Extravasation
You have Indicating Symptoms and if You

defer it until the Latter, that is when Inflamation and 
Suppuration Come on; I say when this happens You
will find it frequently fail, and the Patient do's not 
Stand that Chance he did; had You made Use of 
the Preventitive Method; And when You doe Perform
the Operation it is not in Consequence of the Bone
being Broken, but from the Alarming Symptoms
wch. happen to the Soft Parts from Injury being
done to them; the next Consideration is the 
Objections our forefathers had, the one Reason
was the Air having Access to the Internal Parts,
besides this their Instrument where exceeding
Clumsy are often times to Injure the Membranes
and this render'd them Fearful of Performing the 
Operation; Its very, Strange the fear of Injuring 
the Dura Mater shoud then Deter them, When
their Writings Mention the Dura Mater was not 
Adherent. Mr Patt Says the Ills Arising from the 
Perforation in every Way Consider'd by no means
equal to the Fracture be it smaller larger.
I shall first Mention 2 or 3 Circumstances where 
the Operation may become necessary. If the Bone
be Broke and there should not be any appearance 

of external Violence, You will Consider it as a Contusion
will Bleed and Purge the Patient, and at the end of a 
certain Time as 4 5 or 2 5 Days. Febrile wth. other Symptoms
which will Reduce you to Examin. If You find any 
Tumefaction You will Open it, You then most 
likely will find underneath the Tumour a Quantity
of Sanies, and a Fracture; No Man a Live could
Hesitate a Moment to Perform the Operation,
You will find the Dura Mater Detach'd and more 
or less Matter Form'd, and You Let it out 
immediately and by that Means You'll Give
Your Patient Relieff. You doe not Perform
the Operation because of the Fracture, If the 
Fracture remains then no Harm can Arise from 
that. If Considering it in another Light it 
happens at the Time of the Accident. There is 
a Lacerated Wound of the Scalp; You will Drop it
after the Manner of any other Wound Inflicted
on any other Part of the Body, And at the 
End of a certain Time, the Wound will Change
its Colour and Appearance, and the Pericranium

for a certain Space round, will be Detached
the Perforation, is Now Necessary to Let it out what
was the Cause of the Disease, there is but now 
one Reason why you should Perforate on the 
Fracture and that is where there is a Fracture wth.
Depression, You then are to Perforate in such a 
Manner as for to [illegible]  You to Raise the
Depressed Portion.----

Lecture 10th.
On the Application of the Trephine.
Perforating the Skull becomes Necessary from the 
Extravasation of Blood, or Lymph. I am Now to 
Describe to You the Manner of Performing this 
Operation by Removing a Portion of the Bone,
to Prevent or Remove the Injury Arising from 
the Blow Receiv'd. An Observation Our
Forefathers made was that on Examining.
The Dura Mater immediately a Streak of Blood
was found on its Surface after a Fracture
that in Consequence of this they had [illegible]
to Enlarging the Fracture imagining the Sanies
Decpt from the Edges of the Fractured Bone and they 
through fear seldom Performed this Operation.
Whoever Varios the Instruments they made
Use of will not Wonder at their Fearfulness
One Error amongst the Rest was their Manner
of Applying their Instruments to which was 
Usualy to one side of the Fracture, His Call'd
the hepan and it is a very bad Constructed

Instrument and the operator Labours under a great 
many Difficulties, and Inconveniences, but its
certainly an Improvement, the Instrument Now the 
of is Call'd a Trephine, and is much better
Constructed than than other. The Skull is Perforated
to Prevent or Remedy any Evil Arising from
Injury done to the inner Parts, from the Blow
Receiv'd by Perforating, Your Intention is to 
Remove such Injury. When You are going
to Perforate the Bone, You are if possible, to fire
Your Instrument in such a Manner as to Include
both Edges of the Fracture, the larger Your Trephine
the better and which I would always Recommend
to Your Use, When You have Perforated a small
Way into the Skull, You are to Remove Your
Instrument from Time to Time, and thus going 
on gradually and wth. Caution, the Operation
is Capable of being Performed wth. Safety.
But one Perforation will not doe, If You 
find a Deluge of Matter, and the Dura Mater
a Considerable Way round Detach'd You will 
be Obliged to make a Second Perforation 

in Order to give an opening to the Matter there 
Secret'd and sometimes a third will also become
Necessary, You had almost better to Let a Part Perish
than to make an Idle and insufficient Attempt; I 
Recommend to You if possible to Remove the 
whole Fracture, it sometimes happens after
some Days after the Operation Your Patient will
have Febrile Symptoms Come on; And other 
Appearances which will Render You able to Judge,
that there is a Lodgement of Matter, You are then
Necessitated to a Fourth Perforation. In a simple
Fracture You have not so good a Guide in the 
beginning as in a Fracture Attend'd wth. a Depression.
In that Case the symptoms are such as Lead You 
to Judge, from the Pressure made on the Organs
of Sensation and Motion, You are then to Perforate
on the side in Order to Elevate such Bone, therefore
the Instrument is applied different in this Fracture
from the simple in Situation in Situation I would
always Remove a great Part of the Depressed
Bone, and not Content Myself wth. merely Elevating 
the Bone. If You doe it is more than two to one 
that Your Patient will Perish, You shoud if those 

is a Hazard of the Bone [illegible] get a proper Assist
to Elevate the Bone, which You Perforate. In the 
simple Fracture You have one Object to Remove (viz)
the Cause but in that wth. Depression You have two
the Cause and the Depressd Bone; there has been
much said about the Dressings and Bandag's 
after the Operation, all Kind of Initiating and 
Depressing Applications should be Avoid'd, I Know 
of none better than soft Dry Lint, You can not 
Apply Your Dressings too Light for this Reason
I would Advise [illegible] other Bandag's than
merely to Retain the Dressings, for this 
Purpose a Common Yarn Night Cap, which is 
Capable of being Dilated and makes an equal
Pressure, the different Bandag's delineated
in Books are very Prejudicial.---- 

Lecture 11th.
On Extravasation, and Concussion of the 
Brain, and Caries of the Cranuim
In the Fourth and Fifth of the Reading Lectur's, I have 
Endeavour'd to Point out the Prognostic's Appearances and 
Method of Treating all Cases Arising from Extravasation
Extravasation of Fluid, And Commotion of the Brain, in 
Two very Distinct and different Causes, they may 
Arise from wth. or wth.out a Fracture; Extravasation
from what Cause sooner it may Arise is different in its 
Appearance, it may either be in a Fluid or in a 
Coagulated Form, or as I have seen it a mere 
Lymph, or Lymph mixed wth. Blood, it is likewise
as differently Situated; sometimes between the 
Skull and Dura Mater, and at other Times between
the Dura and the Pia Mater, and sometimes in the 
Ventricl's, it may either be in smaller or in a 
larger Quantity, upon this Depends in a great 
Measure the sooner or Later Appearances of the 
Disease, and from its different Seat so will You
have greater or less Hazard, when it is situat'd 

the Skull and the Dura Mater, it is not so
hazardous, as when Situat'd between that and 
the Pia Mater, and still greater when its Situat'd
between the Ventricl's, one Unhappy Difficulty
We all Labour under, in Extravasations, they have
different Kinds of Symptoms tho we may always
Judge of Pressure by the Patient Loss of sight
and Voluntary Motion, Yet We cannot be certain
of the Seat of the Extravasation, yet in that Instance
where there is a Depression of the Bone, We have is 
sometime in our Power to Cause an Absorption of 
the Extravasation, I have Seen Cases where the 
Extravasation has happen'd in the Venticl's, and 
the Symptoms Come on Gradatim, Which
Plainly Shews the Lymph is to be Shed gradually
what Kind so ever the Extravasation, either of Blood
Lymph or Coagulum, there are but two Methods
Proposed for their Treatment the one is to Cause
a free Evacuation, and the other by Perforation,
at the Time the Blow being Receiv'd, If You
have a Contus'd or Lacerated Wound, You have then
some Sort of an Authority where to Lay Your
Trephine, When You have not such sort of Apperances
You must Perforate in such a Manner, as Appear 

The most likely to Remove the Blood or Lymph
Your Dressings must likewise Coincide wth. Your
Intentions, all those which Cause Irritation must be  
Avoid'd; It vary often happens after You have Perforated
the Skull You will find the Dura Mater of a Silver
Colour, at others of a quite different appearance; No Blood
or Lymph is to be Seen, on the Surface of the Dura 
Mater, and it is Elevated where the Perforation ever made
made, it is a Doctrine recommend'd by some Writers
to Divide the Dura Mater but unless there is Blood
to be formd, and there shall be appearances, such
as Change of Colour on the Dura Mater, and such 
other Symptoms as Lead You to a Necessity of 
Making such a Division, I by no Means Advise
You to Divide the Membrane, but where You have
these Preceeding Symptoms Attend'd wth. an Elevation
of the Scalp, You will there have Mischeiff underneath,
and you must then Divide it; If at the Time of the 
Accident a Piece of Depressed Bone or any
Foreign Body shoud Lacerate the Dura Mater
ill Effect will then Arise, so likewise from 
Lancet or Bristory, tho I dont regard the Perforation
I seriously Advise the Division of the Dura 
Mater, I was sent for to a Boy a few months ago to 

belonging to Christ Hospital, when I soon found
a Fracture Occasioned by a Part of a Scaffold falling
upon his Head. I trepan'd him and from appearances
Judg'd of Necessity to Divide the Dura Mater, by 
which Means a Quantity of Coagulum was Discharged
and the Boy was Instantly Releiv'd, and Remains
now in Perfect Health. A Concussion of the 
Brain has been spoken of in a general Manner
but it is a distinct Disease, and should only
be Consider'd in a single abstract Manner.
By a Commotion I mean such a shock as has
been Given to the Medullary Part of the Brain,
as happens to both Cases from Persons being
Knock'd Down, they have a Swooning this Arises 
from Commotion and is not the Effect of Pressure
As I have seen several Instances from a fall
a Person shall Receive an External Injury upon
the Head, but having when falling been in such 
a Position as when sitting has Given such
a Shock to the Brain, that has been follow'd by 
such Symptoms as that Death, has often
been the Consequence, the Patient becomes
Irrational, frequent Bleedings wth. Opening
Medicines should be made Use of 

for the Operation, all You can do is to Procure
Evacuations wth. regards to Wounds Inflicted on the 
Meninges they should be treated, in such a Manner
as will best tend to Prevent Inflamation; It remains
now to Tell You the Certain Place for Performing
the Operation, You are Justly Forbid to Perforate the 
Skull on the lower Part of the Os Frontis; On Account
of the Frontal Sinuses's, Another Part in which We
are forbid by Writers is the Posterior Part of the 
Os. Occipitis, the Os Temporum, is another Part to
hear of Dividing the Temporal Muscle, but those 
Writers Consider'd not that it was impossible to 
Perforate the greatest Part of the Parietal Bone,
without the Previous Division of that Muscle and 
its Tendon, Another Cause of Fear was the Division
of the Artery, the Locked Jaw is a Local Disease
and do's not Arise as some Imagine from a Division
of that Muscle, Our Forefathers forbid the 
Perforation on the Sutures, Supposing the 
Hemorrhage would be so great as to Prove 
Dangerous; I by no means Recommend the 
Perforating the Sutures where You can Avoid it.
I doe not Mention it as I would have You
Guilty of Rashness, but to Show You the 

Longitudinal as any other Sinus may be 
Punctured, without that Danger or Ill Consequence
Arising from it, I once Purposely open'd the 
Longitudinal Sinus of a Woman I hapen'd which 
instead of Producing any ill Effect rather Gave
Releiff. A Caries of the Cranium sometimes
happens and is Produc'd from Two Causes, the 
one is from External Violence, and the other is from
the Lues Veneras About ten Years ago an Elderly
Man was Riding in his Coach, was by a sudden
Joilt thrown from his Seat, and Struck his Head
against an Iron which was fasten'd at the top of 
the Coach, he felt at that Instant an Acute Pain 
but it soon Went off. Sometime after I saw him,
and found his Head in an Erisepellatous State
there was a small Wound, and upon Examining 
I found the Bone rough; and to my great
Surprize Reced'd from My Fingers, which 
immediately Gave him immense Pain, I Remov'd the 
Carious Part and then soon became Well. In a Venereal
Cause they likewise become Carious when the Disease
when the Disease in the soft Parts. A Mercurial
Process is Useful, but the Moment it Cease to but

as a Medicine it becomes a Poison. I have been an Eye
Witness to this in Numberless Cases, when the hard
Parts are Attach'd You must have a suppuration, and this 
is only to be Effect'd by a Nourishing Diet, and where 
it may be proper to make use of the Hard Recruit.--

Lecture 12th.
On the Fistula Lacrymalis.
The Subject of this Lecture is Commonly, tho
improperly Call'd the Fistula Lacrymalis, there
is no Disease wth. which the Human Body is Affect'd
has Caused a more Variety of different Opinions
amongst Writers than this has done; the Ancients
where very Erroneous in their Method of treatment,
their first great Cause of Error is their having 
mistaken one Part for another, they likewise
being Unacquainted wth. the Part where the 
Lacrymal Fluid was Secret'd; you will find both 
amongst Ancient and Modern Writers a Variety
of Opinions about the Seat or Lodgement
of this Fluid, their Descriptions are Inaccurate
they where of an Opinion that the Caruncle
became and In Cyst'd Tumour, but they all
Agree in this Point that of an Induration
and Caries of the Bone according to their 
different Opinions, so likewise they differ in their   

Manner of Treatment, they who Imagin'd the Diffusion
more from Inflamation and endeavor'd to suppurate
the Carunculi others by making an Incision to the 
Carunculi in Order to Eradicate it, and others
made Use of Ecsharotic Applications, Whoever
Treats it in this Manner can never succeed in his 
Intention, by Irritation it is Certain You encrease
the Disease, Vision could not be Perform'd
wth. that Facility it now is unless the Surface of 
the Coats where Kept Continually Moist, and free
from Dust or from any Irritating Body, the 
Lacrymal Glands Serve for keeping the Tunicæ
Cornea Moist, and bright and to Remove
any Dust from this Coat, when by Accident
they are Stimulated either by the Passions
of the Mind, or by any Extraneous Bodies, the 
Lacrymal Fluid becomes so much increased, as 
to Run down the Cheeks, it is then Call'd the 
Tears, when the Disease Exists, it is sometimes
so Avid as to Occasion Excoriation, of the Skin
the Quantity of Fluid is not Known, the 
Lacrymal Sac is Situat'd in the Ductus Nasalis

which Opens into the Nose, behind the Os Spongiosa
Inferiora, the inner surface of this Duct is Besmeared
wth a Fluid to Prevent any Irritation. The Fluid
Devis'd from the Lacrymal Gland is Facilitated
by the Motion of its Lids, is Receiv'd by the 
two Puncta Lacrymalis and then Convey'd into
the Sac, those who Labour under this Disease
from what Cause so ever it may Arise have this 
Sac Obstruct'd, the Consequence of this is the 
Tears run Down the Cheeks, this Disease as 
its Origin from a Variety of Causes. In the 
beginning from improper Treatment sometimes
after the small, Rose, or from the Mucus Membrane
which the Lacrymal Sac being Obstruct'd.
The Moderns Say that this Disease in its
first State Arises from a Lodgement of the 
Lacrymal Fluid, all Obstructions of the Fluids
when Lodged become very Hurtful. Its Colour
Depends on the longer or shorter Existance of the 
Disease, so do's the Colour Change. It has been 
Improperly Calld Pus, as I Mentioned before,
It Arises from a Variety of Circumsances and 
is Attend'd wth. such as Form Obstruction in the 

Nasal Duct, If by ill Treatment the Bones should
become Carious, as sometimes happens from the 
Pore Polypus or Cancer, so according to the Disease
and other Circumstances, You are in a great Measure
to be Guid'd, in the Manner of Treatment, or other Means
You are Oblig'd to make an Opening for the Discharge
of the Fluids, some of the French make Use of a Syringe
to Inject the Sac. If it will Pass from the Lacrymal
Sac into the Nose it may doe, but whoever will
View the Syringe and Probe they make Use of will
See the Impractability of the Operation, Compress and 
Bandage have sometimes been made Use of wth. Success, but 
then this Pressure must be in such a Manner upon the 
Bay as will Remove the Obstruction, and avoid
giving Irritation, I have tryed that Invention of Mr Sharp's
but is Proves Ineffectual, You will find in the 
memoirs of the Royal Academy at Paris, a Variety
of Methods for to Remove the Disease, there Two 
Methods now Observ'd, the one I think very Rational
the other rational Method I recommend to You 
is this, by making an Incision into the Duct and Passing
the Knife in such a Manner as not to Injure the 
other Parts, having made Your Incision, You are then 

to Apply Lint, in such a Manner as to Preserve
Your Opening, and then gradually Dilate it by a 
Piece of Spunge or Bougie, or a Piece of Lead,
which must be Introduc'd to Pass the Nasal Duct
and thereby gradually Dilating the Opening, a Cure
will be Effect'd; the Tent must remain in Three
or Four Months least the Disease should be Renewed
the Scar by these Means will become very simple
this Disease is often very difficult to Cure, but its often
Owing to their going on Dilating and Causing
Inflamation, which ought always to be particularly
Avoid'd, all Kinds of Bandages or Pressing Bodi's 
are Prejudicial; I am now to Inform You of the 
best Method of making a New Channel, when either
by this Treatment or any other Cause it is so Obstruct'd
and not to be Remov'd. The Ancients made Use 
of the Caustic and Terebra, when we doe it We only
Mean to Perforate into the Nose, the most frequent
Method for this Purpose till Lately was the Cautery;
Mr Chapaldon Stands first for the Inventing and 
making Use of this for the Removal of this Diseae;
I have Seen many Disagreable Effects Arising from it 

for in Spite of all Your Efforts to the Contrary You will
Destroy the Neighbouring Parts, which most Certainly
You ought to Avoid doing; For the Purpose of 
making this Opening, there is a much better
Contrived Instrument, the Curv'd Trocar, when You 
have made Your Perforation, which You will Know
by Blood Passing through the Nose, then Apply
Your Tent of Lint, and then some Drawn Lead to 
Maintain the Opening taking Care to Avoid
giving Cause to Inflamation, and lastly not 
to Remove Your Tent till the Time above Mentioned. 

Lecture 13th.
On the Cataract.
The Eye Consists of Three Coats, tho there are 
some who have made five. It has likewise the 
Humours. The Tunica Sclerotica, the Tunica Cornea
which is Transparent, and the Tunica Retina, wn.
The Tunica Ubia and Iris; the Humours are the 
Aqueous which is the Anterior, the Chrystalline
and Vitreous, which are situated Posteriorly,
the Diseas's of which I am now to Speak have been
much Misrepresented, by Writers, it has been Supposed
as Consisting of a Variety of Circumstances, it has 
however one Plain Disease, It is an Opacity
of the Chrystalline Lens by Vision is Variously
Imped'd or wholy, Destroy'd, it Varies in its 
Appeance and Colour (Viz) of the Pearl Blue
Brown &c, the general Doctrine in regard to this 
has been that at first when the Disease has made 
a small Progress, it was then Immature; but as 
the Disease increased it then became Mature 

and fit for the Operation. That this Doctrine is not 
always true is very Certain, I have several Times seen where 
from a Blow being Receiv'd, the Chrystalline Lens becomes
immediately Opake; Again I have seen where the 
Cataract her remain'd in a Fluid State all the Time
The Disease has Exist'd, therefore the Shortness of 
the Time making it Mature or Immature, is Uncertain
I have seen the Chrystalline of a Living Animal as 
Capable of Resisting as in the Dead Body, the 
Dissolving of the Chrystalline Humour is Proceeded
by a Pain of the Head, in those that appear
While and Indurate is sometimes the Effect of 
Age, there are some Circumstances which Determine
the Event of the Cure. If the Patient and 
Opake Chrystalline can Perceive the Light there
is scare Hopes of Success, but if the Patient
cannot Discern the Light there is a little more.
Besides the Dissolved and Indurated Cataract
there is Another which has been Term'd the sheting 
Cataract, another Circumstances which shoud be 
Consider'd is the Mobility of the Papillae, which 
if immovable is very Favourable, but if not the 
Operation should not be Attempted, If You Look 
into Books You will find a Variety of different 

Methods for Performing the Operation, the Disease
in its Cure is simply, there are two Methods of 
Operating now in Use, one by Depression of the 
Chrystalline Lens which is the Oldest Method, the 
other is by 3 Extraction; the Latter took its Rise
from Accident as many other Improvements
in Surgery have done, to Extract the Chrystalline
Lens You make a Transverse Incision on the 
Cornea a taking Care not to Injure the Eyes when 
its Coats Unite, by this Means You will Preserve
the other Humours from falling out, in Order to 
Depress the Chrystalline Lens, You Pass
Your Needle in the same Manner, but Pass Your
needle into the Posterior Chamber of the 
Aqueous Humour, You are then to Turn Your
needle breaking Down the Cataract, and when the 
Papilla becomes Clear, You are to Depress it,
sometimes it will rise again on the Patients
Stooping Down, and again Sink Down on the 
Patient being Erect, sometimes it happens that 
the Division of the Cornea will not Unite, and 
a Quantity of Humour will fall out, the Light
still remains, the best Method I think is that 

by Depression, as You have not so many
Inconveniences Attending it as by that of Extraction
after the Operation a Plaister of Soap Cerate shoud be 
Applied and the Antiphlogistic Regimen follow'd
frequent Bleedings to Prevent Inflamation, and 
if necessary opiates should be Administer'd. 

Lecture 14th.
On the Polypus and Hair Lip
The Polypus Narium is a Disease concerning which both
Ancient and Modern Writers have given very 
different Accounts, wth. regard to the Manner of 
Treatment, but that it was one distinct Disease,
It has however very different Appearances, and 
is Attach'd to different Places, sometimes from 
the Septum Narium, or from the Pituitary
Membrane, sometimes from the Os Spongiesa
or Hanging from a stalk. It is sometimes
Indolent and at other Times Not, and the Bone
to which it is attach'd will sometimes become
Carious, whoever fills himself up wth. Hopes, that
a Polypus will be easily Cured, will find himself
much Deceiv'd. the Cheiff of the Ancient Writers
seem to have been at great Pains, to find out 
some Remedy to stop the Hemorrhage which
they Imagin'd happen'd after every Polypus
was Extracted, and this seems their Grand Object 

in View, but Venture to Lay that those Kind
of Polypus wch. admit of Extraction and are Curable, that 
from these no Hemorrhage will ever Ensue, wch. will Require
Assistance to Stop, I never Saw but one Kind of Polypus
which would Admit of Extraction, or being Cured, More
Kinds of Polypi that are not moveable and are
not differently Affect'd by different Kinds of Weather
and that Put on a Cancerous Appearance, had much
better be Let alone for by Attempting this You
will not Succeed, that Kind of a Polypus, that may 
Admit of a Cure is that which is Movable in Respiration
When the Patient has no Cold it Appears as if 
filld wth. Colour'd, Lymph, and that on taking
Cold becomes troublesome, and in rainy Weather
becomes Enlongated and enlarg'd. If Frosty becomes
less and Contract'd, and on Pressing it a little
Fluid Drops from it, those Polypi which doe
not Answer this Description, will not Admit of 
the Operation; Escharotics which have been made
Use of in this Disease Serve only in My Opinion
to encrease it, some have made Use of Ligatures
but it is difficult to Pass them high enough to the 
Rest, without that You doe not remove the 
Disease; the Polypus is generally Attached to 

the Os Spongiosa; the Method of Extracting
the Polypus is to Pass it up to as near the Root
as possible, a Pair of Forceps wth. Holes in and 
Fall down in a Reight Direction, and not by
Forks, and Hoisting the Forceps and You will
Detach it, It sometimes happens a small Portion
of Bone will Come away wth. it, but to this 
You will Pay little Regard. Those Writers
who Say a Polypus will Grow again, from 
the same Place where the other was Detach'd
have Wrong Ideas. Those which are so much
enlarged as for to Hang Down, and appear
in Sight, either without the Nostril or behind
the Velum Pendulum Palati, are all distinct
Polypi, and that after the Removal, of one error
You shall have another in a short Space.
It has it Attachment at another Part, and 
will Come Down in Consequence of the other 
being Remov'd. 

The Hair Lips
The Hair Lip is of Four Kinds, two of which are Confin'd
to the Lip only, the third is attend'd wh. a Division of the 
Manilla Superior. The Fourth is Attend'd wth. an Horizontal
Protrusion of the Denticular Ridge of the same 
Bone in the first which is only a Simple Division
of the Lip You are to make an Incision on each 
Side so as to Remove the Callous Edges, and Procure
a Speedy Reunion Some have been of an Opinion
that when this Discovers itself at Birth it is much
better to Put off the Operation for a Time, for these 
Reasons Children are apt to Cry, and are apt to 
Endeavour to Remove their Dressings, but these
are very Triffling Objections, for My own Part I never
Object to Performing the Operation, but rather 
prefer it at an early Age; After having Pared
of the the Edges, You are to Introduce Your
Pins and Suture which is the best Method, tho
I have seen the Common Interrupted Suture wth.
Sticking Plaisters doe very well In the Second
You will have two Separate Divisions Opposite
Incision You can not Heal both at the same Time, but
having Perform'd one and suffer'd it to Heal to and [illegible]
the other Under the Division of the Lip You will

sometimes have an Horizontal Protrusion of 
the Maxilla Superior which Comes under the 
Fourth Kind, this must first be Remov'd before You
Attempt the Cure in this Case the Dentes
Incisioi must be Soft, being Oblig'd to Remove
a Portion of the Alveoti sometimes there is a 
Division through the Maxilla; And in this Case
You will Expect to the Benefit; the Impediment
in Speech the Difficulty in Drinking must 
all be Submitted too all You can doe is to 
Unite the Soft Parts, and render the Deformity
less Obvious; The Pins now made Use of are now 
much Improv'd. There Points Screw off which 
Prevents many Inconveniences both to the 
Patient and to the Nurse, which before they 
where greatly liable to.....

Lecture 15th.
On Diseas's of the Trunk
and Thorax.
I shall Divid them into Two Heads, first those that 
happen within the Cavity; and 2d. those that happen
without the Cavity, there within are the Vomica 
Empyema and Hydrops Pestoris, those without are
Wounds and Fractures of the Ribs; Empyema
Cancerous and schirrous Breasts, Wounds on
the external Parts are Triffling, but You must Pay
Attention to Prevent, Inflamation, which is 
Liable to happen, from the Lungs in Respiration
Those Wounds which Penetrate the Cavity of 
the Thorax are Matter of Consequence, they should
be Dressed as Quick as possible, to Prevent the 
external Air, which besides Compressing the 
Lungs, and necessarily Preventing a free
Respiration, will likewise Impede the Circulation
of the Blood, and Stagnating it in the 

Right Auricle. Those Consequences will Arise from 
Wounds Perforating the Cavity of the thorax independent
of any Injury Communicated to the Lungs, and 
which the external Wound Appears largeness
sometimes Unhurt. tho in Perpetual Motion
free Respiration and the Impulse of Blood.
When any Injury was Communicated to the 
Lungs, the Ancients Pronounc'd it Fatal. But they 
are not always so. It Depends upon what Part
they are Wounded; At the lower Part they are 
not so Dangerous, the Ramification of the 
Artery are not so great as they are high up
But the Danger in a great Measure Depends
on the Size of the Wound it may be Raise'd high
up Yet the Patient may Recover. from any 
of the above Mentioned Causes, the Lungs may 
be either Compress'd, or Inflat'd so as to Prove Fatal
by the Blood, Stagnating in the Right Auricle
of the Heart, A Case that I saw a few Years
ago will Prove the none Fatality of a Wound of 

the Lungs; A Boy a Waiter at a Tavern running 
up Stairs hastily wth. some Knives in his Hand
Slip'd Down, the Knives also fell and one of them perpendicular
wth. the Handle of it in a Hole, which the Boy
fell upon, I was Sent for and found a large Wound 
on the Right Side, and from which when a 
Candle was Held to the Part, was immediately
extinguished by the Air returning out.
There was some Hemorrhage, but that Ceas'd to Flow 
of itself it was Drop'd Lightly and Speedily
and the Boy did well, not Attend'd wth. any 
bad Symptoms; there Accidentaly some of the 
Vericulae Airiae was Wound'd on the Surface of the 
Lungs, when the Wound was Exposed he was in 
great Danger then of suffocation; therefore Nature
Led him to Cover it wth. his Hands, which he 
was Obliged to especially in the Night, when by
Accident the Dressings where Unavoidably
Removed, Fractures of the Ribs are Painful
and Troublesome, the Method of Treating them 
is to Kind a Napkin round the Body, Oily 

Medicines, Opiates and the Antiphlogistic Regimen
shou'd be made Use of to Prevent Inflamation, but it
sometimes happens that of spicula of the Fracturd
Ribs will Press through the Pleura and Wound
the Lungs; the air then Rushing into the 
Cavity fills the Tela Cellolosa, when every Part
of the Body which has any Cellular Membrane
will be Distended also and Cause the Disease
Call'd Empyema, the Lungs will Perform
their Office wth. great difficulty and the 
Patient generally Dies of suffocation, and 
non Circulation; Puntures and free Incisions
are Said for to Cure the Labor, I prefer as it 
will give a more and greater Passage to the Air
You are then to make Use of Friction upon the 
Emphysematous Tumours, wth. Your Fingers
which are always to be Oiled to Prevent giving
Pain and Inflamation, Yet Notwithstanding all
this it is mostly Fatal. The Breasts of Women as
liable to many Diseas's; Abscesses are what 

I shall now speak of; they are very frequently
Caus'd by the suppression or Driving Back of the Milk
which Custom Rewards the Intention of Nature,
which is done to Avoid Trouble or Suckling of the 
the Child, or to Avoid Sporting the Shape of the 
Regular Form of the Breast. Woman should be 
Persuaded to Suckle their own Children, as the 
Mothers Milk Purges off the Meconium, and is 
much more Nourishing than that of Another Woman.
As that peculiar Quality which is in the first
and nearest Milk, is here Wanting in the Strangers
Breast; Render by this they will Prevent the Fever
very frequently occasioned by the Stoppage of the 
Milk, and likewise the Causes of Abscess and 
Indurations; these Kinds of Abscess Incident to 
Women, from the above Mentioned Cause have 
been generally ill heated. The Common Method
which hollow'd in the beginnig was to apply
Adhesive Plaisters over the Breast, and where 
a fluctuation was Perceived, there they Apply'd
Caustics, which Methods by Prudent Men 
are never Practised, some make Use of Means to 

Discuss or to make Absorption and a Suppuration
as we have it in our Power to Assist by either of these
Methods to forward Suppuration, You are to 
Attempt by gentle Evacuant, and Emollient
Poultices Continued till it Bursts, as it then
generally makes a more Depending Opening.
Caustics should never be Applied. If it should not 
Burst of itself, a Puncture will become Necessary
which should be made large enough to give free
Passage for the Matter, As by this Means You 
will be Prevented from making Another, Your
Business is to keep the Divid'd Lips of the 
Wound asunder, by this Means You will give
free Passage to the Matter, which is of the 
Utmost Consequence to Your Patient and to Your own
Character some have Imagined that the Matter
has Pointed in such a Manner, as You will not 
be Able to make a free Discharge, from the 
Nipples being in the Way, but they have been
Mistaken, for You may always Avoid
Wounding the Nipple.---- 

Lecture 16th.
On the Schirrous Breast.
Our Forefathers Gave the Name of Shirrous to all Tumours
that would not Admit of Disputation; The Moderns
Term those Schirrous which will not Admit of 
Suppuration and Bears an Affinity to a Cancer
sometimes only one Gland becomes Indurated at others
more and in some the whole Breast, It Appears
sometimes Indolent and not Painful to the Touch
in others it will not Bear the Touch without Giving
Pain. Whenev'r the Nipple is Retracted the 
Schirrous turns Cancerous, and is generally Fatal;
there are two Methods of Cure, the one by Destroying
it by Caustic, the other by Extirpating wth. the 
Knife; The Idea and Dread of Pain given by 
the Knife, has Induc'd many who Labour under
this Disease, to suffer Ignorant People Unacquainted
wth. the True principal of Surgery, to try those 
Pernicious Secrets which they too open Impose
on the Credulous People as Efficacious, they  

Attempted the Removal first be applying Plaisters
for that Purpose, when these fail'd which they 
always will doe, they Apply'd Caustic which 
are very Painful and Uncertain. Tho there is no 
Appearance of a suppuration, Yet the Diseas'd
Part will not be Clear'd from the Sound, the
Pain is greater than that of the Knife, and of 
longer standing. If You apply Your Caustic
too strong You may Injure the sound Parts,
If too Weak it will not Remove the Diseas'd Parts
and it will also by its Irritation encrease it 
and make it much Worse.
The Composition this Caustic generally Consists
of is Meadow Crowhoot Dog fennel Sulph
Vioum and Arsenick, made into a Paste wth.
the Yolk of an Egg, this is in their general Use
and Come from Stevens Hospital in Dublin,
this is their Boasted Secret, and which many
People are tortur'd wth. the Knife is the best 
Remedy if the Operator Knows how to Use
it, and is Acquainted wth. the Seat of the 

Disease, and Anatomy of the Parts, always
Remembering to have as much of the Sound Skin as
Possible. If the Schirrous Gland Lies deep so that there 
shall be some Cellular Membrane and Adipose
Situated between that and the Skin, you must 
make a Longitudinal Incision which will 
sufficiently enable You to Dissect out the Glands
at the same Time Preserve the Skin. The Cancer of the 
Breast has a Variety of Appearances and Appears
under a Variety of Forms, it is sometimes Painful
sometimes Movable, and immoveable, When 
Movable in a favourable Circumstance, it Indicates
there is a Cellular Membrane between it, and the 
Muscles of the Latter it is Unfavourable, and 
should not be Attempted, as the Cellular Membrane
is Indurated, and is Attach'd Firmly to the 
Ribs, a small Degree of Mobility should not 
Deter You from Performing the Operation,
Circumscription is another Circumstance which 
is when the Breast shall be Perfectly Movable
but the Parts of a few Inches round shall be  

Adhering, this also shou'd not be Removed as 
You most likely encrease the Disease
sometimes You will have the Milliary Glands
as large as Grains upon the Breast, this also
shou'd not be Removed, as you most likely
encrease the Disease, and bring on Additional
Pain. Whether the Breast be Ulcerated or not
it should be no Impediment against Your
Exterpating it; If the Pain be very Severe You
should Suspend the Removal of it, so also of 
the Glands in the Axilla or Neck be enlarged or 
Indurated, it is a certain Proof the Disease
Exists in the Habit. I have Mentioned a Variety
of Circumstances which are Prohibitions for 
Performing the Operation; the Prospect of Success
in Those Cancers which Arise from Internal
Injury are greater than those which does not 
as the Latter Indicates a Disease of the Habit.
A Cancer in the Scrotum Attend'd wth. Darting Pain
in the Back is Dissuasive, tho not always a 
Prohibition it sometimes being Local, 

A particular Circumstance to be Observ'd, is the Obstruction
of the Menstrual Discharge, which You should be Careful
to Perform before the Operation; On the other Hand if the 
Menses have Ceas'd to flow, their Bodies will undergoe
so many Changes, that You will have many Difficulties
to Encounter. The Present Method of Operating is this;
the most Painful Part of this Operation as in all 
others is in Dividing the Skin, which tho I am an 
Enemy to Calarity, shoud be done as Quick as 
Possible, You are to make two Semicircular Incisions
round the Breast into the Membrane Adiposa
Dividing Downwards to Dissect it from the Pectoral
Muscle, Leaving it as Bare as Possible, and 
taking Care to Remove all the Diseas'd Parts,
You will have but few Vessels to take up as the 
greatest will Retract themselv's; You shoud then 
Dress it Lightly wth. Dry Lint, and not to Remove
Your Dressings for at least four or Five Days being
Elaps'd, in short untill Suppuration is fully and 
Establish'd, as they will fall off themselv's, You will
then have a Clean Sore. But I am Sorry to Say 

after all Your Care, You will sometimes not 
Succeed, The Sore will have Promising Appearances
and shall Heal Kindly until about the Size 
of a Shilling when its Appearances will Alter,
it will become Glassy and will Spread, it will
Degenerate into a Phagedenic Ulcer and the Patient
will become Hectic and Die.---- 

Lecture 17th.
On the Hydrops Pectoris
The Disease may Arise from Two Causes, when the 
Body is Affected wth. a general Anasarca, and when it 
is Confind solely to the Cavity of the Thorax, the 
Hydrops thoracis is the same Kind of a Disease as 
the Ascites in the Abdomen, they both Arise from 
one and the same Cause, there is a Fluid Constantly
Transuded from the Pleura, which is Constantly
Absorbed; Whenever this Secretion becomes greater
than the Absorption, An Accumulation of the 
Fluid must certainly be the Consequence of it 
and which Causes the Disease; The Symptoms
of this Disease Laid Down by Writers are very 
Erroneous; the Disease may Exist and the 
Patient during Life may Suffer very little, and 
the Cause will not be known till an Opening after
Death. The Symptoms which Indicate the 
Disease are very great Depression and difficulty
in Respiration, especialy upon any encrease
of Exercise by the Lungs being Compress'd the 

Circulation will be Imped'd in some Measure
and the Blood is accumulated in the Right 
Auricle, in an Erect Position the Patient do's not 
Suffer so much, as when he Attempts to Raise
himself or Lay Down hastily, and again he 
becomes Easy by being Kept Quiet, these Observations
will Lead us to Distinguish it from other Diseas's 
when the Lungs are Diseas'd it may be Known 
by the Expectoration, which by this Means generally
Leaves the Patient; the Hydrops Pectoris is external 
to the Lungs, therefore Expectorants will not 
Releive, from the Extravasation of this Fluid,
which should Circulate through the Body;
The Secretion of Urine, becomes less in Quantity
but this is not Specifically in the Hydrops
Pectoris. Another Symptom is the Palpitation
of the Heart, from the irregular Motion of the 
Muscles, and is very Different from that 
Palpitation Arising from ye Spasms. The 
Intermission of the Pulse in this Disease is no 
Uncommon thing, nor is it Specifically Attendant
on it. It has been Apart'd by Writers that You may

Know the Disease, by the fulness of the Chest or on 
one Side, but I never was Able by any such
Appearance to Ascertain the Existence of any such
Disease; where there are certain Indication of this 
Disease, You should not neglect to Perform the 
Operation; a Variety of Methods have been Propos'd 
in Order to Perform this, such as the Introducing
the Trocar in the same Manner, as is done in the 
Ascites in the Abdomen. The Method Recommend
to Your Practise is to make an Incision about 
an Inch and a Half long through the Integuments
between the Sixth and Seventh Ribs Counting
upwards near their Angles doing it very Carefully
to Avoid Wounding the Intercostal Artery; You must
Direct Your Knife, near the Inferior Edge of the 
Superior Rib, You are not to Use the least Pressure
upon the Knife, but Use it wth. the same Caution
as when Performing the Operation for the
Prubonarale, You may then safely Divide the Pleura
the Vomica of the Lungs, this Disease is a Collection
of Matter in the internall Surface of the Lungs
Arising from Inflamation; The Cure of this Disease

is sometimes Effect'd, by the Matter being 
thrown up by the Trachea, tho sometimes it must 
Prove Fatal, by the Quantitey of Matter being so 
great as to Cause Suffocation; In a Collection
of Matter upon the external Surface of the Lungs
or in the Cavity of the Thorax, which some Writers
have Mention may be Known by Ocular Demonstration
have also Mentioned the same Method of Cure as in 
the Hydrops Pectoris.----

Lecture 18th.
On Vomica and Empyema
In all Internall Dises's of the Lungs amongst wch. the 
Vomica is Mentioned, Expectoration always is a 
Salutary Sign, when there is an Accumulation
of Fluid in the thorax, the Disease is Term'd Hydrops
Pectoris, and when the Lungs are Diseas'd Previous
to this Accumulation of Fluid the Symptoms
are different, to what they are when there is no 
Disease in the Lungs, they likewise differ when 
there is Adhesions these Circumstances You
shou'd Carefully Consider; There is another Disease
of the thorax, which generally is not Form'd
until after Death, We never Know when the 
Patient is Living. The Hydrops Pericard the 
Cause of this is the same as sometimes happens
between the Tunica Vaginalis and Body of the 
Testicle, and of the Disease already Mentioned
the Hydrops Pectoris, from too small a Quantity
of this Fluid Secret'd Adhesions take Place, the 
tumor I believe to be a Cause of Sudden Death, and 

in those who have a very Irregular Motion
of the Heart, the Lungs are Liable to many Diseas's
Inflamation Suppuration and Induration and 
frequently Subject to Adhesions, by Previous
Inflamation; the Lungs sometimes become
Suppurat'd; when the Matter is freely Expectorated
it is a Salutory Sign, in regard to that 
Matter which has made its Way through the 
Surface of the Lungs, so as to become Floating
in the thorax, Expectoration can be of no Service
and the only Way to Cure will be by making
an Opening to Discharge the Matter, after
the Method above Prepar'd, but there are no 
certain Symptoms which Indicate this Disease
Occasion'd by a Previous Adhesion of the 
Lungs to the Pleura, the general symptoms
of this Disease is Fever hard Pulse a Dry Cough
Parch'd Skin difficulty of the Breathing wth.
an Incapability of Lying on the Side not Diseas'd
without great Pain. By Means of Adhesion
a Fever Produc'd by so Necessary an Organ 

As the Lungs beine Prevent'd from Performing
an Office, so Necessary to Vitality. In Adhesions
of the Lungs, the Patient find Complains of a 
fixed Pain, so small that he can Cover it with 
his thumb and the Pain is encreased on the 
Patients taken in the Air. Adhesions is follow'd
by Irritation and Inflamation which
which is the Consequence of Suppuration, at this 
Time the external Parts become Load'd, and full and 
this fulness is Circumscrib'd which is the Seat
of the Matter. If the Lungs are Adherent partly
from the Inflamation and Pain; the Patient 
Avoids taking in Air freely; as the Disease encreases
the Matter will make its Way between the Ribs;
the Tumour will Appear somewhat Circumscrib'd
in its Figure it is hard in the Middle and Painful
farther from the Centre it is of the Œdematous
Kind, Joind wth. an Erysepellatous Appearance
as it Proceed. You will Perceive evidently
a Fluctuation, and being Satisfied there is 

Fluid Examine it no more, by this Means You will
Avoid giving Your Patient any Unnecessary Pain
and what is of still greater Consequences and 
happens from Pressure You will have the Tumour
Disappear, and the Matter will be Loose in the
thorax, and will be Attend'd wth. Fatal Consequences.
Your Business is always to forward Suppuration
by keeping the Skin Relax'd wth. Poultices.
There are some who Attempt to forward Suppuration
by Adhesive Plaisters, which only tend to Inflam.
and Irritate the Parts, And in My Opinion ought
to be Let alone, but I know of no Application to 
Assist Suppuration. Nature alone if Left to 
herself is generally sufficient where there is no 
Elevation of Parts, Evacuation wth. the 
Antiphlogistic Regimen becomes Necessary,
But when You have such Symptoms and 
Appearances as shew that Nature is Dispos'd
to Suppurate, You are then to Abstain from 

general Evacuations; when the Fluctuation of 
Matter is felt and the Skin Puts on an Inflammatory
Appearance, You are then wth. Your Lancett to make 
a Puncture, having done this You are to Introduce a 
Probe Pointed Bistory, and make an Opening sufficient
to Discharge the Matter, and then Carefully Attend
to the Habit of the Patient; You are to Apply some 
Lint to the Lips of the Wound to keep them from 
reuniting till the Matter is entirely Discharg'd,
this is sometimes so great as the Patient will
Sink under it. sometimes the Discharge will be 
Continued so long that it will be in Appearance like 
Sanies, it will be Requisite, You shoud apply
a Canula or Use some Means to Reserve the 
Wound Open, taking Care to Avoid all Applications
which Tend to Irritate and Inflame and Nature
will then Compleat her End.----- 







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POTT. L.W.
Lectures on Surgery.
1[8]773-4.

Mr. Potts Surgical Lectures A.D. 73. and 74.

Mr. Potts Lectur/s
on Surgery.
The Introduction
Gentlemen 
My Intention in the following Course of Lectur's
is to treat on the Useful and Important Science
Surgery; and shall not Concern myself in Giving You
a Minute Anatomical Knowledge, or Description
of the Bark; but merely so much as will be hurt
Necessary for our own Purposes, This where I to doe
would be Altering the Plan of My Lectur's; and 
therefore must Defer You to Your Anatomical
Teachers and Books. My Intention is merely to give
you the Practical Parts of Surgery, and which
I shall Endeavour to Say before you, in the most Clear
and Precise Manner that I am Able; some have
Disput'd it being a Science/ others an Art; but it most 
certainly Justly Claims the former. It is needless
to Urge any Encomiums upon on its rise As it is so 
Clear and evident to all Mankind; It was Instruct'd in 
the earliest Times, and different Methods was Pursued
to become the Surgeon; come merely by Perusal

of Books, and Attaind only theory, and there
became by far the Ablest Surgeons in the Closet,
and were apt in Conversation y but in the Practice x
Part where very greatly Deficient, and frequently
at a Loss. And on the other Hand those Introdu'd
by Practise, only wth. the Use of Reasoning or Books,
Labour under an equal Disadvantage, in being
Able to Perform an operation, Dexterously without
perhaps Knowing why it should be done or when it 
is necessary. Different Writers have followed different
Plans, all of which are equaly Defective, and in 
this Particular, they have Confind themselves
in Describing the Modes of Operations merely
wth only wing? You a Clear Account of the Disease,
which requires the operation; they have Given you
the operating Part without Mentioning any Disease
or Prohibitions to any Operation which [Da???]
many Principal Writers [cross out] Labour under; it may
perhaps be Expect'd of Me as is Usualy the Case in
Introductory Lectur's of this Kind, to Give You
an Abstract History of Surgery, which I [cross out] had a 
Power or Capacity to does would Ingross too much of 
that time which I think can be better Employ'd in Parts 

more Beneficialy and Instructive to You; or should 
I do it, it would be only giving You a Series of names
and States. However any one who has Curiosity in him
to Desire to Know this will find the History fully
mention'd in Galens History of Surgery, Clarkes
Surgery; or by Dr friends; the Majority of Writers
have fined a Numerous han of Bandages, and 
Instruments. The first is almost Unnecessary and in
general Prejudicial, nor is is Worth my while to 
Describe them, or Yours to Hear them; the Instruments
are also tedious and Unnecessary, they are very numerous
and an operation was never Perform'd without a great
many of them being Us'd; the Surgeon was never
Imagin'd, unless he produced, or was posses'd and
[illegible] a great number of Instruments; on the 
Contrary I think they cannot be too simple, and
simplicity wth. Respect to Bandages, as well as 
there is always to be Commend'd. There few Bandages
and Instruments which are Useful cannot be too 
Simple, I shall at a proper time Place [crossed out] Describe
them to You; Whoever has the Curiosity to become
Acquaint'd wth. them will find them fully Describ'd
by Scaltehia, and likewise that general Compiler 

of Surgery Neistery this will Instruct You in the 
Choice of Instruments, they are well Described and 
You will find also their Uses. The Methods the 
Teachers of Surgery have follow'd in this. Van
Norn as Divid'd into the ten following Parts, or
Smthutic under which are Dang'd all fractures
Wounds Ulcers and Bruises. The Diabetic; as the
Operation for the hepan, the Eartic or the 
Extraction of Stones, or any rousing Bodies.
The Chartic, as the Extracting of Polypus Excursions,
the Prosthetic, as the Putting in of artificial teeth,
Ey's and Woodan 1 Leg's and Dicorhetic as the 
Management of in Curvat'd Spines. Limbs and 
Clubb feet; and this Plan is regular and very
Superficial, but not at all to be Copied in a Course
of Chirurgical Lectur's. It is Confin'd to the 
Operative Part moraly, a Part very Necessary
to be known, but it Heads not to the Knowledge 
of Diseas's. A Young Man by Studying this method
woud become an Operator, without Knowing why to 
Perform the Operation. He may perhaps doe it when
not necessary Dexterously. First become Clearly
Acquaint'd wth the Nature of the Disease, than where 

the Symptoms shall In. Indicate the operation
and lastly Perform it in the best safest and easiest
Manner as Possible. In Order to render You Capable
to accomplish, thinks may Intention in the following
Course of Lectur's, and which I shall Endeavour to Lay
before You in the most Simple Manner. My Plan
is to make My five or six first Lectur's general,
and to Speak of those Diseas's which are Confin'd
to Particular Parts but are liable to happen in all
Parts of the Body, and having finish'd those begin
wth. the Scalp; and so End regularly wth. the 
Extremities. The Art of Surgery cannot have
too much Said in it Praise, it Unto quite, and 
it Utility, and when properly and Honestly
Practic'd cannot be Deserving of too much Praise.
The Utility of Surgery is well Known to every Rational
Man, Whoever Deflects on the Diseas's liable to be Inflict'd
wth on him, and the Body will immediately on this 
Proposition; Was not the Stone extracted out of the
Irritat'd Bladder what must not evidently have been
the Consequence; On the Contrary the Fracture of a Bone
by proper Position and Assistance of Bandage care,
and Reduction of it may be Accomplished and in 
and in Time the Reunion of the Bone and a Happy Cure.

A Bleeding Vessel, also Point out it Utility, 
for without the immediate assistance of Surgery the 
Patient will Die from the Loss of Blood, the Surgeon
from nearly a fatal End will Restore the Individual,
to his former h Strength, and Health. must more 
might be Said to Elucidate its great Importance are
its Utility. but these Instances Clearly Points it
out, and the best Speaks in Own Praise; Many
People I am Sorry to say it (Consider Surgery under
too different Lights. If Practising only for the 
Sakes of getting a Livelyhood, very little Art
and Abilities are then requir'd, but Considering it as
a great a noble Science it Requires Steady
Applications. Abilities and Integrity; and as You
get this Requisite Acquisition, You will Despise
and Abominate the other; the Surgeon should be well
Acquaint'd wth. Plain [crossed out] Anatomy, that is the Muscular
Parts and especially their Us's, and Simaliar,
when Contract'd and when Relax'd, he shoud under [under???]
the Constitution of every Joint, and the whole of what 
is Call'd the the Animal Œconomy, such as Digestion
from the Mastication of the food, in Passage to the 

Stomach and Stay [illegible] there, and then the formation
of Part of it into the Junction of Bile, and the Conversion
of the food into fœces and Expulsion per Anum, and 
without which he cannot Obtain a Compleat Knowledge
of Surgery. This will Undoubtdly take up some time
it is at the first Difficult, but is easily attaind
by a little Cloose Applicaion, and Perseverance.
A Surgeon shoud not only Know Anatomy but should
have a Competant it Knowledge of Physics and
shoud be very well Acquaint'd wth. the Action and 
Quality of Medicines, As in the Country he cannot 
have the Assistance of Calling in a Physician. A 
Compound Fracture in the first Place will take on Inflamation
and Febrile Symptoms Attending it, which will
Require Medical Assistance, in the last State of it will
from it many Symptoms require a Different and 
Careful Treatment; Surgery not only Consist in Pleuing
the Limb in an Advantageous easy Position or
Dressing or Turning it wth. great neatness and 
Dexterity, this will not Deceive a Patient of his 
Principal Complaints, He may Sink from a Diarrhea
Dysentery or Diabetes, and He must have Medical
Assistance. If therefore Behooves You to be well 

Acquaint'd wth. there the Complaint for the 
Removing of them, or You will kindly annals greatly
Embarrass'd; and from the Meriti that Reputation
which ever Distinguishes a good Surgeon.
Anatomy and Physiology are absolutely necessary
make the Surgeon to there should be added natural
Physiology it ought therefore to from Part of your
Studies, as that will Point out to You the Beauties
which attend the Noble Science, and greatly assists
the natural Genious, and Explains to Us the 
many Divisions Nature sometimes Puts on and
to these must be added, and Temperate Steady
and Resolute Patients Injuring and not Bias'd
by Prejudices, and not to be Led by the first 
appearanc's as Not in Unmanly his Resolution
shoud by no means Lead him to Barbarity or He 
shoud make a Distinction between the Senseless
Dead and Sensible and the [illegible] Irritable
Parts of a Miserable and Unhappy but falling
Patient; thus are the branch in Falling to a Cruelty
in their Operations. Who on reading their Tracing of the 
Spermatic Chord Five or Six Inches up into the Abdomen
for the Removal of Schirrus Testicle and Chord

could ever suppose they ever did it but on an 
Animal Body or that if otherways less than Mad Men
for the Attempt. Now they doe this cannot be Conceiv'd
by a Rational Surgeon, Yet if they Lay this Down 
as a Matter of part, and that have been Produc'd, I can not
Preceive that this has ever been Peform'd but on the 
Dead Body. When a Surgeon Comes in Practise in the
Highest Sphere and is often Calld upon, He must
have other Necessary the Qualifications) An Eye an
Hand and Temper; this Eye is as Gold Pleaser to 
give him, is Hand may if Defective may be Owing 
to himself and his Intemperance; therefore in a 
Surgeon to Live a Temperate Life; His Temper shoud
be mild and be engaging, and not to frighten the 
Irinarous without the Appearance of Brutality
which is always to be command'd, and for a farther
Recital for their a Accomplishment and Necessary
Qualifications belonging to a Surgeon, I will Defer
You to Surgical Writers who have fully treat'd of it,
that a Physician will always be the best Practitioner
who has a a Knowledge of Surgery, and in like Manner the
Surgeon who is the Acquaint'd wth. the Use and Quality
of Medicines, Writers in Surgery may be Divid'd into 
Two Classes those of general System, and those of 

particular Diseas's; the former have not Time enough
to kill as Minute Diseas's they doe little more 
than Give out Lines and Copy from Another; the 
latter You should lead more Attentively, and Pay
always more Respect to Yourself, and Let Your  
own Judgement be always Accompanied wth. this
System Comparing it with Your own Observations,
and Practise Shews to You And then Act accordingly,
Surgery has within these 50 Years been Improv'd very 
much, but Let not that excite Your Vanity, but tend
rather to excite Your Ambition, by Assiduity and
Study farther Improvements, for no Doubt some 
Years hence Our own Successers will be as much 
Astonished at our Ignorance, as We are at our 
Predecesours; Many Useful Improvements, We Owe
to their Use, from wch Fool hardy Practitioners
and Ignorant Quacks; Thus was the Present Later a 
Operation for the Stone, Invent'd by one From Jacques
a Person of no Education. Therefore Knowledge
may be beg of from the Ignorant as well as the Learn'd 

and indeed most of the Useful Discoveries in 
Physick and Surgery have been Effect'd through Ignorance
and Chance. Now Whidaly different is the Small Pox
to what it was a few Years ago, I woud always Have 
in Medicine between the Custom Practise of Religious
well Meaning Practitioners; and the Foolish Variable
Practise of others, nor ever Listen too greedily to 
my sudden New Putting Practise, before You have 
thoroughly Consider'd it; Now with Respect to Your
Studies Compare Your Reading with Your Observations
that You may be able to Form Distinctions and 
Differences, which You may Regulate in Your Notes;
the frequent Dissections of Dead Bodies is absolutely
Necessary, To know the Situation of Parts and 
how Construct'd &c. This will Give You above the 
Rest the sole use of Your Hand in Respect to the 
Operative Part of Surgery, and which cannot be 
Obtaind but by a Dissection. In Performing 
an Operation, always Remember You have a 
Body before You, indeed wth. the greatest Degree
of Sensibility, and wth. the most exquisite healing
therefore Give the least Possible Pain Imaginable

be not too Quick nor Strive to Shew Your
Dexterity, by doing which You may Cut Parts
which ought not to be Cut. but be Calm and 
Let this be a general Rule with You, if its well
done its soon done; I have now only to add, if I shall
Give You any Knowledge in these Lectur's, which
is My Intention to doe; You Oblige me by Improving
it by study and assiduity and then to Practise
as an Honest and Judicious Surgeon- 

Lecture 
On Tumours 1st.
Before the Discovery of the Circulation of the 
Blood and before the general Distinction of the Fluids
through the Body, owing, it was thought the Principal
Fluids where from (viz) Blood, Bile, and Pituatar
and Anobitis, or the Melancholy; and that these when 
and or due Regulation, where not only necessary to, but
even the Source of Health; it was likewise Supposd
that the Redundancy or Dimination of these Fluids
or Numours, was the Cause of Different Kinds of Tumours
Namely Phlegmonous, Erisipelas, Œdema, and 
Schirrhous, that these Opinions are foundd on
Matter of Fact, is hard by necessary to Observe; in
this Place We still keep up the Manner of Distinguishes
Tumours into four Classes, because We find
the Divisions are very natural, and that all four 
Require different Kinds of Cure, the Phlegmond
is not Confin'd to any particular Part of the 
Body, but it may happen any where; Its more or less
a hard Circumsensible & Tumour, it attend'd with [illegible]

Degree of Pain, and Puts on an Inflamatory
Appearance of a higher red Colour, the Patient
has frequently some Degree of Symptomatic Fever and 
commonly is Preced'd by a Slight Shivering in 
Proportion to the Degree of Inflamation; this is the 
common and the most frequent appearance of the 
Phlegmon; but it may from many Circumstances
put on a Variety of Appearances; the Seats of this 
Disease or Tumour is in the Dela Cellulora, or the 
Membrane expanded over or between the Muscles,
for Lubricity, and the Membrana Adiposa, the
former is [illegible] then suppurated; and the 
latter is Partial; so it arises from Obstructing
the Fluids Secret'd by that Membranes, for the 
Lubricity of the Muscles, which it Covers. This
Obstruction Continuing Produces an Induration
which on the Consequence of an Inflamation and 
Suppurating the Phlegmon on Account of the 
Method of Cure is Divid'd to Two Kinds. for were
it is not be Caused by one Previous Disease of the 
Habit, secondly where it is the Normal Termination
of some Disordh of the Habit in general; As for 

Instance the Crisis of a Fever. In the first Place the 
Discussion of the Tumour; should be attempt'd by the 
Antiphlogistic Regimen Emollient Cataplasms and 
gentle Evacuations by the Lancett, and Lenient Purges
and Diluting Medicines; In the Second Place We
ought to Make [cross out] Use of every Method in Our Power; in
Order therefore to Carry of the Disease; for this Effort
of Nature might Prove Dangerous or even fatal, and 
Discussion is to be attempt'd by Means so well and 
generally known, that it would be needless here to Point
it out the same may be Paid wth. regard to be the Methods
to Promote Suppuration, when the Matter is Completely
form'd in the Tumour, thus because the swelling could
not be Dispers'd or because it was thought proper to 
Promote Suppuration, it is undoubtedly to be 
Let out, but the Manner in which this should be done
has been a Matter of most Controversy. Our
Forefathers did it by either Omission or by a Caustic
the latter was more generally Us'd, because by this 
Means the Matter was more Effectually Let out of 
the Abscess; on the Account of the Opening they made
but in this they do not seem to have any great 
Regard to the Pain Occasiond be, this Application

of the Caustic and the Indelible Sear Necessarily
Left behind; when they open'd by the Knife it was 
Customary to Cram the Sore with Lint, afterwards [cross out]
Using not Medicines as they thought Promoted
Suppuration, [illegible] the Contrary when not at all
Calculated for it, by this Means the sore was Surround'd
for a Considerable Space with Inflamation, therefore 
what Contribut'd to the Opening greatly of the Abscess
by Caustic was that there who made use of the 
Knife did by their Erroneous treatment of the Sore 
afterwards; and this then brings their Method into 
Contempt and Disrepute; Incision is much the best
and what I would Recommend to You. This either
making a Puncture or a large Opening wth. a Stroke
of the Knife will Answer the End, You Arrivd at
which is only to Evacuate the Containd Matter, and 
this will always be found the most Useful and Beneficia
to the Surgeon or the Patient they thought that 
the Cavities of [illegible] [illegible] made by the 
Destructing and therefore they thought that they 
where to fill it up again with Flesh and Us'd such

Medicines as they Call'd Suppuratives and
Digestives to Promote this End; the Method Brought on
all those Evils which they Want'd to Avoid. The 
Use of the Caustic they Imagind was a Specific and 
after Leaving the Eucher to Slough off they form'd
the Cavities filled up, and therefore without Considering
the true Reason they Preferd the Caustic, for when the 
Application of Caustic was Us'd they never fill'd the 
Cavity with their Suppurative Medicines Lint &c. He 
is well Known that Matter is Form'd by the Melting Down 
of some Membranous Parts, but this Been a very
small Proportion indeed to the Quantity Form'd of Matter
and Nature herself as soon as the Matter is Let out to 
Contract the Cavity. And We only are to take Care of the 
general Health, and to Maintain such a Opening
as to Present a Judgement of Matter; for the Sear of the 
Matter is often out of the Beast of Our Dressings
and Yet Nature Comes through Abscess as herself. Then
this We find from the filling up the Cavities of Abscesses
with Lint and the Escharotic Dressings was truely
wrong and Prejudicial. And that soon if we where not to 
Apply any Thing the Cavity will be Contract'd.

And upon the whole, We may Allow that the 
Application of a Caustic is hardly even to be Us'd; In
[illegible] simple Phlegmon, the fever generally, Ceases
on the Formation of Matter, but as this do's not always
happen the Assistance of Physic is Necessary; Inflamation
do's not always Terminate in [cross out] either of these two Ways
but sometimes End in Gangrene and Mortification, this 
is generally attend'd wth a Disease of the whole System
when the Habit is Mended and the Gangrene Superficial
Nature herself will Throw it off but when the Part
is entirely Speculated it requires Changes to get 
rid of it, when the Gangrene Succeeds great Pain
and fever &c then We are able to Say the Gangrene
has spread more Internally than what appears 
externally, and if the Operation of Amputation must
be Perform'd higher than the Part Gangrened; and 
the Part Mortified Separates Considerably
above the Discolouration, and is Discharg'd into 
the Cellular Membrane, and always up above
the Mortification. The Operation must not be Stop'd 
before the Mortified Part begins to Separate
for the Mortification can never be Stop'd by an [illegible]
We should above; Attend to the Patients general 

Habit and Counteract such Symptoms as shall at 
the Time Occur, either by Evacuations or the Contrary
and if there is a fair separation Obtaind in 
Consequence of a fair Suppuration Establish'd
this will Point to us the Place where we shoud
Amputate and We should always Wait for this 
not Amputate (as was the Custom of our 
Forefathers, at the Place above for the Reason
of having a good Stump for the additional 
Pain and Consequent Inflamation is very likely
Mortification apart and will often Infallibly
Destroy the Patient; Scarification is thought
to be little more than Scratching the Skin, but 
Gives Pain to no Purpose) If it is meant
to make large and deep Incisions it may 
possiby Discharge a Putrid Lanias and 
Unload the Limb. but it is not Known that
Produces any Sensible Effect. The Erisapelas is 
suppos'd to be Produc'd by Bile it is formd in 
Bilious People and it requires a different 
Treatment from the Phlegmonous. it is commonly
flat and Broad and spreads to a Considerable 
Distance and has not the Scarlet appearance of the 

Phlegmanous and is not so elevat'd or Point'd and 
is generally attend'd with Vesications when large it is 
generally a Disease of the Habit, this Inflamation
may Proceed from Two Causes (viz) either from
too small a Secretion of the Bile, as too great
a Distribution of it, the Causes which may be 
Productive of the Secretion being Imped'd, or 
from an excess of Drinking of Spirituous Liquors
and Debauches of Various Kinds which are the 
Consequence of an Indurat'd Liver for from 
a Salivation, or from a Weakness of the Parts from 
Disease. The Tumour is generally of a Paler
Colour tinged wth a yellow Cast. The Method of 
treating this Disease is to Strengthen the Patient
wth. Cordials Stomachics Medicines Join'd wth. Chalyts
in Order for to Remove the Obstruction and 
to Promote Secretion of Bile, On the Contrary
you must Promote the Suppuration. The other
Kind Arising from an overflowing of the Bile into 
the Stomach Duodenum and Jejunum and is of 
a more yellow Colour. It is generally Accompanied
wth. a fever, there is thirst Amnesty and Nausea
and Inclination for to Vomit and a dislike to food &c.

Neither Dissolves or tends to Suppuration We should
be Careful of the Means Us'd to Dissolve it, when a 
Disease of the Habit, We should Endeavour to Divert
the Bile by Lenient Purges Calculat'd for that 
Purpose, and also to be Careful in Evacuating, wch.
shoud be Done wth. great [illegible]; for it may be translatd
from the external to the Internal Parts, and We ought 
also to attend to the Natural Strength and Pulse
of the Patient, and take Care not to Impede the 
Circulation already began this Method of by
Discussion for ought never to [illegible]
and we are to Promote suppuration when Nature
Seems Inclin'd for to Produce Matter, it is always
to be Encourag'd, there is no method of Discharging
the Matter but by a proper opening of the Matter is not 
then Collect'd in that Circumscrib'd Manner, as in
the Phlegmonous but is left [illegible] in more Places
and the White Cellular Membrane, in a Diseas'd
State and Sloughy two or three or more if necessary 
sometimes the Strength of the Patient is renderd that 
when the Sloughs are separated the Sore has not a 
good appearance. Means the Habit by proper
Medicines and Diet will in good Time enable
Nature to make a Perfect Cure. The Œdematous Tumour

Tumour arises from the Pituitous State of the 
Blood and Juices generally Seat'd in the feet
and Leg's, they are sometimes seat'd in the 
Legs wch. have been Broke, and is Proceeds likew
from an Obstruction in the Absorbant Vessels,
from the Situation of the Leg not being able 
to Perform it Office from time from the Use
of it the Vessels will Receive Elasticity and 
Perform their office, but if it do's not Disappea
the Advice of a Physician is necessary to Remit
the strength of the Patient. The Bark and either
Cordial Medicines Join'd wth. the Chalybeates will be 
found most hope, the Schirrous Tumours. The
Ancient Us'd for to Receive all Indurated Tumours
under this Head but [In?delemus] give that name
taken but that will not admit of Suppuration
by any Means whatev'r; And may justly be Calld
Schirrous or Cancerous, for they are liable to be 
unstated into Cancerous by any slight accident
or a Blow or a Fall, or even the Disposition
or Distraction of a Persons Habit, there are two
Methods Prepar'd for the Removal Extirpation
and Disfaction, the Ancients Recommend'd the 
Caustic as a certain Cure. Duct for my Part

I recommend and Prefer the Knife as I have before done
to your Use; the former is certainly Provid'd you are 
certain of in doing it Business Effectualy, a very
Excruciating Painful Remedy; not let the Patient
who are afflict'd would much sooner suffer the Pain
than Labour to the operation by the Knife and 
Arguments Us'd to Persuade them of the difference
wth regard to the Pain, and the Time of Respiration
is frequently fruitless; the Knife to the Surgeon
who dos [cross out] Know how to Use it, and the Parts he 
is to Cut on, most certainly is Preferable, who 
can Extirpate what he see's is Necessary, and Leave
which is a principal thing as much Skin or will
Collapse and Heal, and having Left but the Remains
of small scar, whereas the Caustic is Productive
of much Pain it totally Darkens the Skin, and what 
is Worse its very apt to doe more in Spite of all
your Efforts to the Contrary; We intend'd to have mentiond or ought
to have done their never has been found was
any Internal Remedy for the Relief of those Tumours
the only one is this Propos'd.----

Lecture 2d. On Wounds
Wounds are by the old Writers Distinguish
into four different Kinds, Incision; Laceration, 
Puncture; and Contusion but in Order to Give you
a more Clear the Idea of them I should Describe
them under the following needs.
Just those which are necessarily Mortal
2d. those which are not in Themselves.- 
Neither Mortal nor hazard one but by Neglect
becomes so; of the first, then are Wounds on the Lungs Near 
Cerebrum, and Medulla Oblongata, Aorta Vena,
Cava Receptaculum Chylic, abd Ductus [Thoracic??]
Those of the Second are the Liver Stomach,
Pancreas and Mesentery, the Spleen and Kidneys,
Those of the Kind Inclind to all Slight Wounds Inflicted
in any Part of the Body; the Method of treatment
and Symptoms attending [cross out] those several Kinds of 
Wounds; of Wound shall omitt until I hear of then
Distinctlly, recent Insis'd Wounds, our first 
Intention must be to Procure a Union of the Divd'd Lips
of the Wounds' I have heard by different Writers
on this Subject several Methods Propos'd and likewise
different Sutures a Description of which you
may see in Kaister and other Authors; the 

Interrupt'd or the Common Suture in those slight
Wounds is the best, Not but the Day one may
sometimes be Judiciously Us'd, as in the Jaw and 
others Parts which are Expos'd, Deformity should be 
Avoid'd: We are Advis'd by French Writers before We
bring the Lips together in Order to Constringe the 
Vessels to Apply a little Allum finely Pulveriz'd or any
other Astringent Powders, but this Method will
certainly Irritate their Intention, by Acquiring a
Suppuration to Cast off the Gramous Blood Clott'd
together by means of the Application, and rendering
the Wound from Healing by the first Intention, which it 
certainly will doe if You Procure the following
Method, after having Examin'd the Wound, and 
found [cross out] of there by any extraneous Bodies, as Dirt &c, which
may have Accidentaly get in to it. You are to
bring the Lips of Wound in to Contact; and in
that Position You are to make Your Suture, and 
Cover it with a Pledget; It is the best Way to make 
a Slip Knot, as You may by that means easily
Remove it, but it sometimes happens from the 
Patient Jandancy to Irritation and Inflamation
that [cross out] these Slight Wounds will be attend'd
wth. much Pain, and Inflamation and some
Degree of fever; [cross out] wch. will require some Attention; 

Our principal Endeavours must be to abate
such Symptoms by Phlebotomy, Lenient
Purges, Opiates, Saline Draught, diluting
Liquids and the Like; and likewise the proper
Position of the Limb or Part of the Body Wound'd.
The Prevailing Practice of London Seems to 
Deny the Use of Sutures thinking them that of Useless
and Painfull Methods; but I do differ from [illegible]
own Experience, there who Decline the Use of Sutures Lay aside 
every Useful and Advantagous Part of the 
Art.-- In Lacerated Wounds it may sometimes
be and if You are Cautious and Say come mention
the Strength and the Situation of the Wound, for 
tho they certainly differ from Incis'd Wounds
yet there are some Inflicted Rarely resembling
them; the same Method is to be Pursued, those
Wounds are generally Attend'd wh agrees Degree
of Inflamation; and such Regime greater
Attention, where in large Wounds of this Kind, tho
there certainly is a less Substance whereby the 
Intention by Means of the suture is Frustrated
yet are of Use in Contracting the size of the Wound,
and in some Degree hasten the Cure; If the 

Wound will not Heal from the Loss of Substance
by this Method, [cross out] Consequence Attending
this Method is Trivial, for it will not add to the 
Inflammation, nor retard the Cure; The Suture will
bring the Lips of the Wound more in Contact
and the proper situation; and half of the Bandag's
You will be able sooner to Compleat a Cure. [cross out]
Wounds made by a Puncture are in themselv's inconsiderable
but are Liable to Prove otherways by the Patient
Constitution, the Inflammation, the Symptoms sometimes
Attending them are very Alarming, A Wound Inflicted
on the tendon of the Biceps Muscle, or any other
We frequently find, is Attend'd with much Pain
Inflammation and Rigidity of the Limb from the
Carelessness of the Patient, and from a strong
Position of the Limb, the Surgeon is to Inquire
how and by what Instrument, it was Inflict'd; And
then Proceed to the Patients Relief; if the Part which
is Affect'd be much Swell'd, and Inflam'd and 
attend'd with some Degree of fever and Pain
keeping the Body Open, the Exhibition of Saline
Draughts and Plenty of Diluting Liquors, VS.
Placing the Limb in a Balanc'd Position and [Apply??]
Emollient Cataplasms should be Continued until 

the Symptoms Abate, but after all these Attempts
Us'd the Symptoms instead of Decreasing Increase
and the Limb threatening a Mortification, the 
Use of the Bark Join'd wth. Cordial Volatile Medicines
Antiseptic Fomentations, Cataplasms are to be 
applied to the Part We may by Rare Means Hope
for Releif, but the Disease still Continuing the 
only Resume will be to Remove the Limb.
Of Contus'd Wounds, Those Call'd Gun Shot Wounds are
the most Violent, and under this Head it was the 
Prevailing Opinion, that no Person who had
not been Abroad, And Attend'd Wounds of this Nature
ought not to Presume and indeed were Deem'd 
Incapable of giving any Releif to the 
Patient; the Ancients Support'd that the 
Powder and the Materials wth. which the Wound
was Inflict'd Carried with them a Poisonous
Quality; from this Erroneous Positions, and being
Influenc'd by this Opinion they Treat'd the 
Patient directly Contrary to the Method I shall
Relate in Order to Guard against the Poisonous
Body they Administerd high Cordial [illegible]
Medicines and Aromatic Fomentations by which 

Means they encreased every Symptom of the fever,
Tension and Inflamation, The Practise I make Use
off in the Cure of these Kinds afterwards in the 
following, having Inquir'd wth. what Kind of fire Arms
they were Wound'd or the Wound Inflict'd, and in what 
Position the Patient was in at the time, and likewise
what the Peice was Load'd wth. You are then Carefully
to Extract the extraneous Bodies there in Lodg'd
but in these Wounds tho they have admitt'd
a Bullett, the Muscular fibres from the Irritation
it Causes generally a Contraction, and You will
Scarce be Able to see the Parts were it Enter'd.
In this Case it will be proper to enlarge the Wound,
if the Part will Permit, which You will be able
to Judge from its Situation, and with the Help
of a Pair of Forceps Extract it; but it happens sometimes
that it Enters so Violently, that it may by making 
an opening be much sooner and easier Extracted
on the Contrary Side almost through the Limb; having
Cleaned it as much as Possible the next thing
Propos'd is Dressing, which must be very Softend
Lenient; and entirely freed from any Irritating
Quality, the Digestion, the Balsam of Bartholomeus
Hospital Applied to the Wound and Covered
with some Warm and Relaxing Cataplasm
will Prove.-- 

Serviceable, and must be Continued some time; there
must be also some Attention Paid to the Inflammation
which must be by, Bleeding largely, Glysters
Given Occasionaly, with Plenty of Diluting Liquors,
Observing a Low Regimen, and not forgetting
Opiates to Appear the Pain; after a Plentiful
Suppuration Comes on, The Bark may be 
Prescrib'd wth. Success. If any of the Vessels
should be Divid'd You must first take Care to Secure them
by a Ligature before You Attempt any 
Application, a great deal has been Said
Concerning the Method of Stopping Hemorrhages
there has been Four Methods Prepar'd (Viz) by Pressure
Stypticks of Various Kinds, the Needles, and 
Ligatures, and by the Cautery, in some 
Cases Pressure may doe very well and 
certainly do's when it is gently Us'd, but 
it is too often apt to Occasion Mortification
by a too Strong and Continued a Pressure;
Styptics may sometimes be of Service, those 
of the Escharotic or Corrosive Kind are Prejudicial
and ought never to be Us'd in small Bleedings
I have made a tincture of Gall Nuts in the 

Rectified Spirits of Wine, and Balsam Fraumat
which has been very Efficacious; the Needles and Ligatures
are by far the best, and inert Method; and what 
I would Recommend to Your Practise, always
take up the Vessels as Naked as you can. And
never Include the surrounding Cellular Membrane
for as that begins to Suppurate, the Ligature
becomes Loose, the Artery will again Dilate and 
You will have a fast Hemorrhage [cross out], which will
now perhaps be very difficult to stop. As by the 
Last Method by the Cautery it is too extremely
Painful and highly [cross out] Unnecessary, and that is 
now Universally Explod'd. 

Lecture 3.
On Fractures
Fractures are by Surgeons both Ancient and Modern
Divid'd into two Kinds', Simple and Compound; what
is Meant by the Simple Fractures is when there 
is a Division of one or more of Bone or Bones,
without any external Wound; And a Compound
Fracture is a Division of Bones, and a Wound
Occasioned by the Protrusion of the End of 
such Fractured Bones; I shall in this Lecture
only treat of Simple Fractures. A Simple
Fracture may be Caused by Various Accidents
as Falls Blows, and which by proper
treatment and Care may easily be Reduced
and Cured; Our Predecessors where of Opinion
that Broken Bones coud not be properly
Reduc'd unless an Extension was made, that would
force the Resisting Muscles, and bring the Ends
of it in a Straight Line, but seperate but afterwards
Suffer'd it to Come into Contact by gradually Relaxing 
the Muscles, this was their general Opinion and 
as such Put in Practise. After having by Extension

and Counter Extension having Plac'd the Ends of the 
Bones in Contact, the Assistants who are Direct'd to keep
it in that the Extend'd Situation, till the Bandage
Plaisters and other Necessary Applications where made;
the Surgeon then having Felt the Ends of the Fracture
wth. one Hand, and gradually applying an Adhesive
Plaister wth. the other, which they thought woud
Act as a Discutient. Next to this they Us'd to 
Apply the Circular Bandage, and to that where 
Plac'd Four Splints, which where made very 
short, to Answer the Purpose as they thought of 
keeping the Ends of the Bone even, and in Contact
and Lastly after every Kind of Compress, a Banadge
as they thought Necessary for the Security of the 
Limb was Applied, and it was rest'd in this Extend'd
Position in a Fracture Bone, made of Wood whose
bottom Lies in a direct Plain. wth. sides to Prevent
the Clothes from Pressing it. As I have Now given 
You a Description of Our Forefathers Practise,
and which I am Sorry to Say it, is still Continued
by some. I shall take the Liberty of Relating 
it to You, the most Safe and Effectual Method
of Reducing and of treating Fractures whether
of the Leg or thigh. Having Put Your Patient 

to Bed and Prepared Your Apparatus which 
are a Pillow and Eighteen taild Bandages a Flir
of Plaister Tapes and Cradle; You are to Place
the Leg so as to have it in a Balanc'd Position
upon the Pillow; and if from Placing it thus the 
Ends of the Bones are not in Contact, which 
generally You may wth. very little Extension
Replace them, this done You are to Apply Your
Plaister on it, the Bandage, and treat the Splints,
which must be only two in Number, and Long
enough to Serve both Joints, which is the Intention
Meant by them; these are to be Lined with [??w] or 
any other Soft Substance, to hinder the Pressure 
on the internal Malleolus or external Condyle
then Secure the Limb in the Pillow by tapes
around to Place over it to Prevent the Pressure
of the Bed Clothes Your Cradle. It will be 
proper to Bleed Your Patient and if Costive
Order him a a Glyster, the Advantage Arising
from this Kind of Treatment is Obvious;
Placing it in a Relax'd Position certainly
Prevents Tension, and Inflamation; and the 
Muscles are thereby hinderd from Acting. The
Plaister which should be applied shoud be of the 

Repellant Kind, much as the Carat Sapon of
Bartholomews Hospital or the Application of the 
White of Egg's and Acct. Spirits of Wine alone or 
Mined wth. Vinegar and Spiritus Minder; all these
are very proper and much more so than the Applications
they Us'd, which where Exp. Robor; Piris; which are apt
to bring are a Necpes and Cause Violent Itching.
The Bandages he recommends are certainly
very advantageous, As it do's not require the 
Disturbance of the the Limb, which the Roller
do's and must Impede the Formation of Callous,
And this Position of the Limb will Admit of the 
Applying of Cataplasms, full as well as the 
other. The Splints are Mentioned before, and must 
be large enough to Secure and keep Steady
both Joints, and may be fasten'd in the Manner
Propos'd; and You must likewise Pay some
little Attention to the Situation of the foot.
Taking Care sufficiently to keep the Bone Level.
This Method strictly Observ'd will have the 
Desird Effect.---  

Lecture 4th.
On Fractures Continued.
Having in some Method Describ'd to You the treatment
of Simple Fractures and the Applications proper
to be Us'd. I shall now relate a few particulars
on each Bone. If the Clavicle be Fractur'd We
are Ordered by our Ancestors to make a sufficient
Compress on the rising Ends of the Bones so as to 
Depress it, and bring the rising Ends of the Bone in 
Contact wth. the Inferior End. but this Doctrine
is Absur'd, Erroneous, and Impracticable; for 
were You to Press ever so great a Weight upon
it, You might Crush the Bone; but would never
answer Your Intention. in Depressing it.
The Clavicle is fix'd to the Sternum and Scapula
by a Ligamentous. Articulation for keeping
at a proper; Distance the Scapula from
the Body; thus when Fractur'd it is always 
Depressed at the End Articulat'd to the 
Scapula from the Weight of the Stone falling
inwards its evident that the former Practise
is Erroneous, and that which they form the 
Chiding End is truely on its Place the 

the only Method of bringing the two Ends into Contact
is to Elevate the Arm until You find the surface of 
the Bone even, then to Apply a Plaister of [illegible]. Supor
wth a small Compress of tow, Securing it by a 
Bandage wch. is to Crop the Bark and Breast
in such a Manner as to keep the Shoulders Back
and Breast as much as can be allow'd of for the case of Your
Patient not forgetting to keep your Patient arm
Elevat'd without which Your other Applications
are fruitless. In the Inactiv'd Tumours; for the 
Reduction of which You are to Relax the Muscle
of the fore Arm, or they will Prevent the Antagonist
and translate your the Intentions, tho You should
Use great Extension, to bring the Ends of the Bone
in Contact; the Method of Reducing it is this 
is to Bend the Arm Setting the Patients Palm
of his Hand be on the Breast. And then if Requir'd
make Your Extension, then Applying Your Cerate
and Bandage either the Eighteen Tailed or Circular
keeping the Arm in the same Position. In a Fracture
of the Arm or, of the fore Arm either of the Ulnar the 
Radius, We are to Consider that We have not
only the Muscles which Perform Flexion and 
Extension, but Pronation and Supination,

and therefore the Arm must be so Situat'd as 
to give these Muscles no Cause to act, having
Relax'd the Muscles by Placing it on the 
Patients' Side, and Rending; You are to
Remember) to place the Patients Radius
upwards, to Place the Palm of the Hand to 
the Patients Breast. and make whole extension
may be Required. after that Apply Your Cerate
Bandage and Splints, Placing it in a Pillow
Secur'd by a Sling in Order to keep the Arm in 
the Direct'd Position. In the Fractur'd Femur
having Put Your Patient to Bed, and Plac'd
him in an easy Position on the Side which
the Fracture is, You are than by Relaxing the 
Muscles of the Leg, to Lay it in an Oblique
Position, And in that Manner make Your
Extension, having got at the End of the Bone
in Contact, You are to Apply Your Bandage
and taking Care to Place the Knee in such
an Elevated Position, as will keep them
in Contact. For a Fracturd Tiberias Tibula
the Leg is to be Plac'd in the same Relax'd
Position, as is above Mentioned. But it sometime
happens there will be a Fracture of the Tibula

wth a Dislocation of the Tibia. which is a Case which
her Perplex'd Our Ancestors much. And by their ill
Treatment made them liable to very Disagreeable
Consequences. Having [cross out] Seen several wth.
very Alarming Symptoms, they Us'd to Place
the Limb in an Extend'd Position, and as they Laid 
Reduce the Dislocation, by making a most Violent
Extension, which was the Practise and wch. is ever to be Condemned,
all that is to be done in this Case is to Lay the 
Limb in such a Position as for a Fractured
Leg, by that Means You Relax the Muscles
and Ligaments Surrounding the Joints, and 
in a great Measure Replace the Mallastus 
Internus which was thrown outward. In this Case
the Tibia is thrown off the Astragalus and the 
Ligaments are Lacerated; but by this 
Method, And Attending to the Symptoms
and Positions, You may Promise Yourself
a Happy Cure. There are Two Fractures in 
the Human Body which Require the Limb 
to be Placed in an forehand'd Position, which 
are these a fracture of the Olcranon and 
the Patella, the Position keeping the Ends
more in Contact, than in a Relax'd or Bent one
[illegible] than Extend'd either the Arm or Leg 

You are to Apply Your Cerate, and Circular
Bandage, Keeping Your Patient at Rest. It
sometimes happens but from what I know 
not or cannot Determine whether its either from too small
a Quantity of the Ossifying Matters or the 
Patients Constitution, that after the Patient
has Kept his Bed for Six Weeks or Two
Months, that the Bone will not be firmd
have Seen this Twice or Thrice in the Os
of the Humeri more in that Bone than in 
any other in the Body. If this should happen
the Method I should advise, and which I have 
found most Useful /is this/ to Let the 
Limb Hang in a Depending Posture for about
the space of an Hour, and to Mind the 
Patients Habit by the ordering of Cost Peruv.
The Relax'd one or Two Cases when the Callus
in a Carinate Patient Produc'd a Caries of the 
Bone, and Loss of the Limb, and when the 
Limb was Remov'd the Cancerous Veins
Attack'd the Viscera, and the Patient Died.
In all Fractures there is a Symptomatic
Fever more or less and some Degree of Tension
according to the Habit of the Patient; You
are to Attend to those Symptoms, and Obviate them

by such Evacuations as You shall Judge necessary
in Pletheric People, You will sometimes have 
a Violent Tension, and Inflamation; and in
Gouty Patients, very often a Violent F.H. which
is a very Disagreeable Circumstance. In all these
Concomitant Symptoms You must Pay the 
Utmost Attention, and make Use of such means
as will be most Productive of Your Patients
Safety, And Your own Reputation. In the
first the Antiphlogistic Regimen will Answer
Your Intentions; In the Second Medicines
and Fomentations Calculat'd for such Disorders
and to Divert the Symptoms attending it.

Lecture 5th.
On Compound Fractures
A Compound Fracture is Produc'd by the Protrusion
of the End of the Broken Bone, through the 
Integuments Covering it, Causing a Wound, whether
large or Small, I shall first treat of one which Requires
very Judicious Treatment, which every honest Man
would Exert his Judgement to Know whether such a 
Limb is Capable of being Sav'd without hazarding the 
Patients Life. In a Fracture, where the Bones are
Broken very Obliquely and at the same Time Protrudes
so as far as to Put it out the Surgeons Power
to Reduce it. Join'd at the same time with a 
Violent Laceration of the Parts; in such a Case
undoubtedly the Operation will be Necessary.
It is impossible for the most Experienced 
Practitioner to Determine whether such a Limb
may not be, but it is certainly most Prudent
to Remove the Limb, in these Circumstances
You run a Hazard of Your Patients Life, for 
in this Case there is no time to be Lost, from the 
Circumstances of the Case must be Urgent.
The Symptomatic Fever must be great and an 

Impediment to the Circulation must be the Consequence
from the Laceration. The Second Case is when the Bones bear
much Crushed or Broken and the Surrounding Parts
so much Build by the Weight, as to Put an End
to the Circulation; this as well as the other will Require
the Operation. The third Case which will Require
the Operation, in having Attempted to Save the Limb.
The Inflamation Notwithstanding You have made Use
of every proper Method, so as to bring on a Gangrene
and then Mortification. Remember this Circumstance
that if You have not Removed the Limb before the 
Mortification has began to Spread; and that Removing
while Spread it will Destroy the Patient, as it will
by no Means a Stop the Putrid Virus, therefore
it behoves every Person to Assist Nature, by such 
Means as will Cause a Separation of the Diseas'd
Parts. The Symptoms Arising on the first Case
are. If the Limb is not Remov'd in a very short
Space of Time, Violent Symptomatic Fever Attend'd
wth. thirst a Parch'd Brown Tongue, and very frequently
a Diarrhea. The Limb at the same Time in an 
Inflammatory State, these symptoms may Continue
two or three Days and then instead of Inflamation
the Limb will Put on a speculated] Appearance 

the Fever is then increased and Attend'd with 
a Singulous and with a Delirium, and frequently
Fetid Stools and wth. Colliquative Sweats, and Death
inevitably the Consequence, An Instance of this Kind
I lately Saw in the Hospital. Where the Tibia
and Fibula where much Broken and the former
Protrud'd, and so much as made it Impossible to 
Reduce it Mr Pitt advis'd the Man to Submit to the 
Operation, but he absolutely Refusing at the 
End of four Days he Died, in the above
Described Symptoms, frequent Bleeding was 
made Use off. and likewise Lenient Purges and 
Glysters so as to keep the Body Open and 
and Abate the the Inflamation; the Bark was 
Administer'd, [cross out] when the Limb Put on the 
Sphacelat'd Apperance. The Volatile juleps
was Join'd wth. it. The Limb was Foment'd with
the Aromatic Fomentation, And a Poultice of 
Wine Les was Applied and Oatmeal. The 
Symptom from the Second will be the same but 
whether they will be so evident soon, I cannot 
Say; but it is very Evident that a Limb
Join'd and Bruised in such a Manner will not 

Admit of the Reunion of the Pieces of Bone, nor 
can We ever Expect the Circulation to be Carried on,
If not the Hemegnance must be from Gangrene and End 
in Mortification, which will have its Concomitant
Symptom's and Destroy the Patient as in the 
preceeding Case, the Method Us'd must be the 
same. And if the Pain is Violent in either Case Opium
must be Employ'd and wth. Success. In the 
Third Case when the Limb has gone on for some Time 
favorably by the Methods which have been
Us'd, it will sometimes happen from the 
Natural Tendency of the Patients Habit, that the 
Inflammatory Symptoms will Return wth more 
Violence than at the first, and all future Attention
will Prove Fruitless. Its still increasing the Limb Put
on a Gangrenous, Appearance, and at Length
Mortification; then it will be Necessary to Assist
Nature in Separating the Morbid Part from the 
Sound Parts, by the free Use of the Cortex, Join'd wth. Aromatic
Medicines; If You can by this Means so far keep up
the Vis Vitae, so as to Cast off the Morbid Parts, and find
You have Stop'd in Progress, than the Operation
will be Necessary on that Part of the Limb it is to 
to be made, the situation of the Parts will Determine 

having treatd on those Fractures which will Require
these Operation shall Relax a few Particulars
on those Symptoms which are more Lenient
We will Suppose a Compound Fracture Caus's 
a small Protrusion of the Ends of the Bone,
And Attend'd which is sometimes the Case wth.
a great Degree of Tension, and Inflamation; all
that is Requir'd is to apply a Pledgit of Cerate,
and the same apparatus as in the Simple
Fractures, but sometimes it happens that the 
same Case, shall be attend'd wth. a great Degree of 
Tension, and Inflamation and Pain, than it will
Require You to Attend Strictly to the Symptoms
and Alleviate them, by such Means as will
Avoid Matter Forming, and hindering the Wound from 
bleeding by the first Intention; To Accomplish this,
Bleeding, the Application of Emolliment Cataplasms;
And if that do's not Answer Your Intention a Weak
Solution of Sal Ammoniac will be proper
likewise Spiritus Minder. Vini Vingear, may
be Applied in the [cross out] [illegible] Cataplasm or after
it has been than Us'd; [cross out] the Inflamation shoud
increase and some Degree of Symptomatic Fever
Attend him repeat'd Bleeding will be proper

If the Pulse will Admit of it, Not Omitting Saline
and Nitrous Medicines. If nevertheless Matter shou'd
be form'd it will be Necessary to Assist Nature, by an 
Emollient Cataplasm, And when a Sufficient Suppuration
in Produc'd to make an Opening in the most Depending 
Part of the Limb; In large Wounds of the Joints, when the 
Capsular Ligaments are Wound'd and a great
Quantity of Synovia is Discharg'd, the Consequences
are generally Inflamation and Gangrene, which render
the Operation Necessary-----

Lecture 6th.
On Luxations
Luxations are Caus'd by Various Accidents, and the 
Knowledge of the Part is Requir'd to be well Understood
in Order for to Qualify a Person to Reduce them.
In Order for to Know this I would Advise You to
Direct the different articulations of the Body
and Pay great Attendance to the thin Ligaments
and Cartilaginous Appendag's there to be longing.
If You are to Remove the Muscles Surrounding the 
Joints the Barral Ligaments woul'd be Joined
in some Incapable of Supporting it in its 
proper Situation, therefore the Origin and Insertion
of the Muscles ought to be Known, and Understood
without which it will be Impossible to Reduce
it wth. ease to Your Patients and Satisfaction
to Yourself. for the Relaxation of the Muscles is 
of Infinite Service in the Reduction.
The Os Humeri may be Dislocated either Inward
Laterally or Downward. it sometimes happens
that the Head of the Bone is thrown under the 
Pectoral Muscle, in the Reduction in this Case
instead of Extending the Arm, and bringing it 

from the Body, You are to keep it near the side and 
Relax the Muscles by Banding the Fore Arm, by that
Means making so great an Extension, as well
bring the Head of the Bone more forward on the Edge
of the Cup and then give Way, and by the least
Elevation of the Bystanders it will immediately
goe into its Place. If the Accident has happen'd
that the Method a Practitioner is able to make the 
off wth. the Hands will not Succeed. I would
Advise you always to Apply Your Towels, or what
ever else You Intend to Use for Your Extension
at the lower End of the Bone, keeping the ForeArm 
Bend'd as by this method all Your Force Applied to
that Bone alone, for if You Apply it as some 
Authors Recommend one Towel on the Luxated
Bone and the other on the Joint below the extend'd.
Force, on the lower is Cast on the Ligaments
which Articulate it to the Luxated Bone they 
Yeild to Extension----- 

Lecture 7th.
On Wounds of the Head.
Whoever will give themselves the Trouble to Reflect on
the Structure and Mechanism of the Cranium and its 
Contents, will Necessarily See the Numerous ill
Consequences, Attending Wounds Inflicted on the 
Head and; Scalp Consists of the Cutis, Tela Cellulosa
Muscular Expansion of the Frontal and Occipital 
Muscles within Tendinous Appendanges, and the 
Pericranium which is Expand'd over the whole
Surface of the Cranium, the Vessels of the 
Internal Pass to Pass through to Anastomose 
wth. the External, If You are Examine the Dura Mater
of those who have suffer'd any Violent Death,
You will find a Number of Bloody Points on the 
Surface of this Membrane, which are the Orifices
of Dilat'd Vessels, I need not mention the 
Treatment of a Simple Wound of the Scalp
as every one knows how to Treat it, but 
it sometimes happens that a great Part of the 
Scalp becomes Detach'd so as to hang Down
like a Flap, this may Arise from the Passage

of a Coach Weal over it; from the Appearance these
Wounds make, It has been the Opinion of some 
to remove the Portion of Flesh should be Remov'd, which Practise
Mr Pott Disapproves off. One Object besides many
others, is that when this Separated Portion of Flesh
is Removed the Patient will never have any 
Pain there Consequently the Patient must ever remain
Bald those Circumstances ought to be Consider'd
therefore the general Doctrine, can Stand upon
no other Foundation, than this where the Suture can 
not be Appli'd, It is very Obvious that all 
Extraneous Bodies, as Dirt &c must be Removed.
If a Suppuration, shou'd happen the Scalp
is by no Means to be Removed on this Account
If Matter be form'd You are wth. Your Lancett
to Let it out, I am of Opinion that a Suture
in most Wounds is best, even when the Scalp
is Lacerated, and the Bone Laid Bare, and 
You should never remove the Scalp except
in one Instance, where You have such Symptoms
as Indicate the Application of the Trephine
than Necessary. It sometimes happens that Puncture
the Skin the Tela Cellulosa, the Aponeurotic

Musclar Expansion and the Pericranium wholly
Injur'd. If the Tela Cellulosa be Wound'd or Injur'd it often
happens the Wound. Puts on a Puffy Appearance
and Vesications Containing a Yellow Colour'd Serum,
there are of the Erisepellatous Kind, and their 
Appearance will sometimes happen in 24 Hours
after the Accident, happen'd it; and will appear
in this Case as if it Proceed'd from some Internal
Cause or Injury but it do's not, although this 
Patient will have such a Nausea at his Stomach
and frequent Vomitings, these Kind of Symptoms
happen in Bilious Habits, it must be Treated
after the Manner of an Erisepellatous Disease
Evacuations by Bleeding Lenient Purges
and Anodyne Poultices, will be found Serviceable
these Cases where well Known, Hippocrates
who Warns the Reader to be Careful in not 
Mistaking this Disease by Supposing it greater
than what it realy is on from some Injury done to 
the Internal Parts. It sometimes happens, that where 
the Muscles and their Tendinous Expansions are 
Wounded whether the Tendons have any Degree of 

Sensibility or not, at this Time I shall not Pretend
to Determine however I am of an Opinion that there 
are Nerves Passing into them, therefore they must have some 
Degree of Sensibility; from Injuries of those Parts You
will have a Tumefaction Come on, And in a Sanguineous
Habit Your Patient will sometimes be Delirious.
This Case highly Requires Evacuations and the 
Pulse will be your best Guide; in the Erisepellatous
Appearances Carefully Attending to the Pulse; If
You make too free wth. Evacuations, and bring the
Pulse below Part, will most assuredly You will
Destroy Your Patient, and You will never have it
in Your Power again to Raise it. I have been Eye
Eye Witness of the many Fatal Consequences Arising
from the ill Treatment of the Disease. There is no 
Disease so liable as this to Translation. An
Inflammation on the Pericranium will Cause it
to be Considerably on the Stretch, it behoves
You here to Divide about two Inches Down to 
the Bone, in the Wounds of the Scalp Fomentation
and Cataplasms, will when there is Inflammation
sometimes Relieve When by an Injury done to 

the Integuments of the Head. The Dura Mater by
Inflamtion becomes Separated; from the Internal Surface
of the Cranium. The Indicating Symptoms of such
Injury as Stupor seldom before the 2, 3 or 5 Day
or even 25 Days from Inflamation and Suppuration
takes Place and the Patients rigors becomes
Exasperated, And in this Case nothing but a 
Perforation will doe, Contusions of the scalp must 
be heal'd by the Discutients; And in all Cases
where there is an Extravasation, be very Cautious
in Prognosticating for it will Appear on the 
touch as if there was a Fracture wth. a Depression
but on the Application of Discutient Remedies
the Disease will frequently Disappear.... 

Lecture 8th.
On Injuries of the Dura Mater.
This Disease was well thrown to Hippocrates who has 
particularly heated of it. I mean to treat of this by 
Mentioning the Injuries, that liable to happen to the 
Dura Mater, from any external Violence on the Integuments
which are always to be Seen in those People who
Die Apoplectic or are Hanged, those Prints which are
then Visible are the Extremities of Lacerated Vessels,
The Dura Mater Serves the same Purpose on the internal
Part of Cranium, and is as Closely attach'd as the 
Pericranium is on the External; If You Perforate
the Cranium of those who Die Apoplectic, You 
will find it difficult to Seperate the Bone from the 
Dura Mater, when from a Fall or Blow a mature
Extravastion shoud happen You will find the 
Extravastion Verge in its Hand and Situation
it sometimes is between the Scull and Dura Mater
at other Times between the Scull and Pericranium
Whenever Situat'd the Symptoms are of Various
Kinds from the most Slight Swooning Down to the most
Comatose State sometimes a Loss of Voluntary
Motion, Hemorrhages from the Nose and Ears 

likewise happen. It sometimes so happens
that the Vessels are so Injur'd as to Cut off all 
Communication between the external Vessels and 
Internal Vessels, Consequently the Circulation must
be Imped'd wherever the Injury is. The Consequence
must be Inflamation and the Vessels put on 
a Sloughy Appearance, Extravasation is 
Caus'd by Detachment of the Vessels, the 
Inflamation then next, Comes on, And the 
Sloughy Appearance Follows, and the Separation
Cast off all, and it Looses its adhesion this
is the Consequence of the Inflamation, You
ought to be well acquaint'd wth. the Manner of 
Distinguishing this Disease, Extravasation is 
Produc'd immediately, and is Symptoms of 
Depression simply, Inflamation is a gradual
Symptom and must be Prevented by Art, When
it happens in the Internal Cavity of the Cranium,
You cannot Know it by the Touch, when externally
you may Distinguish it, When Inflamation
Comes and Matter is Form'd, the Dura Mater begins
to Separate itself from the Cranium; the Pericranium
likewise becomes Separated on the external Surface
there is to be found a Bloody Kind of Tonics

between the Bone and Pericranium, there is also
a Puffiness and a Circumscrib'd Tumour on the external
Part to be found. If in Ten or Fifteen Days Your Patient
should have Loss of sight and other Symptoms. If 
upon Opening the Tumour You a Quantity of Same's
and the Surface of the Bone Put on a Dry appearance.
If Bloody You may take it for Granted, and 
Rest well Satisfied there is Mischeiff underneath
the Cranium We shall Divide the Circumstances
Attending these Accidents, into those Distinct Parts,
The first is (Viz) it very often happens the Blow
shall be such as to have any external Appearance
of Injury, The Patient now has Febrile Symptoms
Come on, Symptoms of Tightness as if a Chord
was bound part, round the Head, has Shiverings
Delirium and Spasms becomes Paralytic and Dies,
this Arises from an Injury between the internal
Surface of Skull and Dura Mater, this Case admits
of no Cure but by a Perforation to Let out the 
Matter, when the Extravasation is externally it 
behaves You to Open the Tumour, and Let 
out the Matter, and now We Consider the Injury
as Attend'd by a Wound, the Blow Given shall
Cause a Seperation of the Scalp, and sometimes
Communicate a Shock to the Vessels, You shall 

Digest the Wound and it shall Put on a favourable [Appeara???]
Appearance, but at the space of a certain Time
he Looses his Appetite, and the Symptoms
happen such as Fever &c; the Wound then immediately
Changes its appearances, the Pericranium will
Seperate for a a Distance round, And You may 
be well assured the Dura Mater is seperated also
and mischeiff is is Forming within the Cranium
the 3d. State is when a Blow is Inflicted in such 
a Manner as to Lay the Bone Bare, which is 
sometimes done by the Surgeon, in this Case You
have not that Guide as you had in the former
Case to goes by, but when the Dura Mater is Injured
You will have the Edges of the Wound all round
the Surface separated, the Bone will Look Dry
and Yellow, when such an Alteration has this 
happens be Attentive to the Symptoms. In all
these Diseas's the greatest Chance is taking it early
by Bleeding frequently, You will have Inflamation
Suppuration Delirium and Spasms, When such
Symptoms happen as Lead You to Judge there
is Mischeiff internally; You must not Wait
but when the Circumscrib'd Tumour wth. its Usual
Puffiness and Detachment happens You shoud then

Perforate the Bone, for if You Wait the Rigors/ the 
usual Attendant on this Disease will Come on, You will
by no Means Give Your Patient a Chance that he would
have had, if You had Perforated the Bone sooner
this is a a Matter of Serious Consideration also to be
Careful that the Disease Exists. If You doe it in
the early State, One Perforation may perhaps doe in 
the middle sometimes two or more are Necessary....

Lecture 9th.
Fracture of the Cranium.
Fractures of the Cranium may be Divid'd into two
Species the first in simple when the Bone remains
even; the Second when there is a Treatment wth. Depression
The Symptoms are Said to be frequent Vomiting a Stupor
and Loss of Blood, from the Nose and Ears, but remember
You are by no means to Rely on those Symptoms
for they may happen Independant of Fracture, and 
when they doe happen they doe not Arise from the 
Solutio Continui of the Bone, they Arise from the 
Concussion of the Brain, or from Extravasation
Seat'd in the internal or external Part of the Cranium
As my Intentions are to Set You Right, I can not
Help repeating what I have already Observ'd, in 
the Preceeding Lectur's without You recollect what 
I have Mentioned. You will be Yourselves at a great
Loss in My Following on's. In the Common Method
of Heaing the Fractured Cranium it is right 
to Perforate the Bone, and there be no Solutio
Continui As other, Purposes are Saved thereby
there are those Causes for Perforation two of which 
are Matters of Necessity; the Head is a Matter of Elation

or Choice, and this is Call'd the Preventitive Kind
of Remedy, the two former from the Consequence of 
Necessity, As when You have Reason to Suppose there 
is a Fluid seat'd in the internall Part of the Skull
it then becomes a Matter of Necessity, the Symptoms
are Caus'd by Violence done to the Vessels or Membranes
and by Fracture, the Performing the Operation
by Way of a Preventitive has Caus'd great Disputes
among Writers, there has been some few Instances
where Fractures have done well without Perforating
but this seldom happens, that was You to Compare
them you would not find an equal Proporation, between
those when it has been Perform'd, and those to
whom it was not, but sure no Man would goe to
Perform an Operation without an Absolute Necessity
The Consequence Arising in the early State from 
Fracture a Extra Inflamation, and in the latter
Suppuration, and if You Compare the Number
of those which Survive when the operation is 
Performed in the former State wth. those who
Perish in the Latter You will find an amazing
Difference, I doe this to this to Show You the 
Absolute Necessity there is in Perforating the Bone
Considering the Number in both Hands, to these 
Cases I shall, add another; In Case of Extravasation
You have Indicating Symptoms and if You

defer it until the Latter, that is when Inflamation and 
Suppuration Come on; I say when this happens You
will find it frequently fail, and the Patient do's not 
Stand that Chance he did; had You made Use of 
the Preventitive Method; And when You doe Perform
the Operation it is not in Consequence of the Bone
being Broken, but from the Alarming Symptoms
wch. happen to the Soft Parts from Injury being
done to them; the next Consideration is the 
Objections our forefathers had, the one Reason
was the Air having Access to the Internal Parts,
besides this their Instrument where exceeding
Clumsy are often times to Injure the Membranes
and this render'd them Fearful of Performing the 
Operation; Its very, Strange the fear of Injuring 
the Dura Mater shoud then Deter them, When
their Writings Mention the Dura Mater was not 
Adherent. Mr Patt Says the Ills Arising from the 
Perforation in every Way Consider'd by no means
equal to the Fracture be it smaller larger.
I shall first Mention 2 or 3 Circumstances where 
the Operation may become necessary. If the Bone
be Broke and there should not be any appearance 

of external Violence, You will Consider it as a Contusion
will Bleed and Purge the Patient, and at the end of a 
certain Time as 4 5 or 2 5 Days. Febrile wth. other Symptoms
which will Reduce you to Examin. If You find any 
Tumefaction You will Open it, You then most 
likely will find underneath the Tumour a Quantity
of Sanies, and a Fracture; No Man a Live could
Hesitate a Moment to Perform the Operation,
You will find the Dura Mater Detach'd and more 
or less Matter Form'd, and You Let it out 
immediately and by that Means You'll Give
Your Patient Relieff. You doe not Perform
the Operation because of the Fracture, If the 
Fracture remains then no Harm can Arise from 
that. If Considering it in another Light it 
happens at the Time of the Accident. There is 
a Lacerated Wound of the Scalp; You will Drop it
after the Manner of any other Wound Inflicted
on any other Part of the Body, And at the 
End of a certain Time, the Wound will Change
its Colour and Appearance, and the Pericranium

for a certain Space round, will be Detached
the Perforation, is Now Necessary to Let it out what
was the Cause of the Disease, there is but now 
one Reason why you should Perforate on the 
Fracture and that is where there is a Fracture wth.
Depression, You then are to Perforate in such a 
Manner as for to [illegible]  You to Raise the
Depressed Portion.----

Lecture 10th.
On the Application of the Trephine.
Perforating the Skull becomes Necessary from the 
Extravasation of Blood, or Lymph. I am Now to 
Describe to You the Manner of Performing this 
Operation by Removing a Portion of the Bone,
to Prevent or Remove the Injury Arising from 
the Blow Receiv'd. An Observation Our
Forefathers made was that on Examining.
The Dura Mater immediately a Streak of Blood
was found on its Surface after a Fracture
that in Consequence of this they had [illegible]
to Enlarging the Fracture imagining the Sanies
Decpt from the Edges of the Fractured Bone and they 
through fear seldom Performed this Operation.
Whoever Varios the Instruments they made
Use of will not Wonder at their Fearfulness
One Error amongst the Rest was their Manner
of Applying their Instruments to which was 
Usualy to one side of the Fracture, His Call'd
the hepan and it is a very bad Constructed

Instrument and the operator Labours under a great 
many Difficulties, and Inconveniences, but its
certainly an Improvement, the Instrument Now the 
of is Call'd a Trephine, and is much better
Constructed than than other. The Skull is Perforated
to Prevent or Remedy any Evil Arising from
Injury done to the inner Parts, from the Blow
Receiv'd by Perforating, Your Intention is to 
Remove such Injury. When You are going
to Perforate the Bone, You are if possible, to fire
Your Instrument in such a Manner as to Include
both Edges of the Fracture, the larger Your Trephine
the better and which I would always Recommend
to Your Use, When You have Perforated a small
Way into the Skull, You are to Remove Your
Instrument from Time to Time, and thus going 
on gradually and wth. Caution, the Operation
is Capable of being Performed wth. Safety.
But one Perforation will not doe, If You 
find a Deluge of Matter, and the Dura Mater
a Considerable Way round Detach'd You will 
be Obliged to make a Second Perforation 

in Order to give an opening to the Matter there 
Secret'd and sometimes a third will also become
Necessary, You had almost better to Let a Part Perish
than to make an Idle and insufficient Attempt; I 
Recommend to You if possible to Remove the 
whole Fracture, it sometimes happens after
some Days after the Operation Your Patient will
have Febrile Symptoms Come on; And other 
Appearances which will Render You able to Judge,
that there is a Lodgement of Matter, You are then
Necessitated to a Fourth Perforation. In a simple
Fracture You have not so good a Guide in the 
beginning as in a Fracture Attend'd wth. a Depression.
In that Case the symptoms are such as Lead You 
to Judge, from the Pressure made on the Organs
of Sensation and Motion, You are then to Perforate
on the side in Order to Elevate such Bone, therefore
the Instrument is applied different in this Fracture
from the simple in Situation in Situation I would
always Remove a great Part of the Depressed
Bone, and not Content Myself wth. merely Elevating 
the Bone. If You doe it is more than two to one 
that Your Patient will Perish, You shoud if those 

is a Hazard of the Bone [illegible] get a proper Assist
to Elevate the Bone, which You Perforate. In the 
simple Fracture You have one Object to Remove (viz)
the Cause but in that wth. Depression You have two
the Cause and the Depressd Bone; there has been
much said about the Dressings and Bandag's 
after the Operation, all Kind of Initiating and 
Depressing Applications should be Avoid'd, I Know 
of none better than soft Dry Lint, You can not 
Apply Your Dressings too Light for this Reason
I would Advise [illegible] other Bandag's than
merely to Retain the Dressings, for this 
Purpose a Common Yarn Night Cap, which is 
Capable of being Dilated and makes an equal
Pressure, the different Bandag's delineated
in Books are very Prejudicial.---- 

Lecture 11th.
On Extravasation, and Concussion of the 
Brain, and Caries of the Cranuim
In the Fourth and Fifth of the Reading Lectur's, I have 
Endeavour'd to Point out the Prognostic's Appearances and 
Method of Treating all Cases Arising from Extravasation
Extravasation of Fluid, And Commotion of the Brain, in 
Two very Distinct and different Causes, they may 
Arise from wth. or wth.out a Fracture; Extravasation
from what Cause sooner it may Arise is different in its 
Appearance, it may either be in a Fluid or in a 
Coagulated Form, or as I have seen it a mere 
Lymph, or Lymph mixed wth. Blood, it is likewise
as differently Situated; sometimes between the 
Skull and Dura Mater, and at other Times between
the Dura and the Pia Mater, and sometimes in the 
Ventricl's, it may either be in smaller or in a 
larger Quantity, upon this Depends in a great 
Measure the sooner or Later Appearances of the 
Disease, and from its different Seat so will You
have greater or less Hazard, when it is situat'd 

the Skull and the Dura Mater, it is not so
hazardous, as when Situat'd between that and 
the Pia Mater, and still greater when its Situat'd
between the Ventricl's, one Unhappy Difficulty
We all Labour under, in Extravasations, they have
different Kinds of Symptoms tho we may always
Judge of Pressure by the Patient Loss of sight
and Voluntary Motion, Yet We cannot be certain
of the Seat of the Extravasation, yet in that Instance
where there is a Depression of the Bone, We have is 
sometime in our Power to Cause an Absorption of 
the Extravasation, I have Seen Cases where the 
Extravasation has happen'd in the Venticl's, and 
the Symptoms Come on Gradatim, Which
Plainly Shews the Lymph is to be Shed gradually
what Kind so ever the Extravasation, either of Blood
Lymph or Coagulum, there are but two Methods
Proposed for their Treatment the one is to Cause
a free Evacuation, and the other by Perforation,
at the Time the Blow being Receiv'd, If You
have a Contus'd or Lacerated Wound, You have then
some Sort of an Authority where to Lay Your
Trephine, When You have not such sort of Apperances
You must Perforate in such a Manner, as Appear 

The most likely to Remove the Blood or Lymph
Your Dressings must likewise Coincide wth. Your
Intentions, all those which Cause Irritation must be  
Avoid'd; It vary often happens after You have Perforated
the Skull You will find the Dura Mater of a Silver
Colour, at others of a quite different appearance; No Blood
or Lymph is to be Seen, on the Surface of the Dura 
Mater, and it is Elevated where the Perforation ever made
made, it is a Doctrine recommend'd by some Writers
to Divide the Dura Mater but unless there is Blood
to be formd, and there shall be appearances, such
as Change of Colour on the Dura Mater, and such 
other Symptoms as Lead You to a Necessity of 
Making such a Division, I by no Means Advise
You to Divide the Membrane, but where You have
these Preceeding Symptoms Attend'd wth. an Elevation
of the Scalp, You will there have Mischeiff underneath,
and you must then Divide it; If at the Time of the 
Accident a Piece of Depressed Bone or any
Foreign Body shoud Lacerate the Dura Mater
ill Effect will then Arise, so likewise from 
Lancet or Bristory, tho I dont regard the Perforation
I seriously Advise the Division of the Dura 
Mater, I was sent for to a Boy a few months ago to 

belonging to Christ Hospital, when I soon found
a Fracture Occasioned by a Part of a Scaffold falling
upon his Head. I trepan'd him and from appearances
Judg'd of Necessity to Divide the Dura Mater, by 
which Means a Quantity of Coagulum was Discharged
and the Boy was Instantly Releiv'd, and Remains
now in Perfect Health. A Concussion of the 
Brain has been spoken of in a general Manner
but it is a distinct Disease, and should only
be Consider'd in a single abstract Manner.
By a Commotion I mean such a shock as has
been Given to the Medullary Part of the Brain,
as happens to both Cases from Persons being
Knock'd Down, they have a Swooning this Arises 
from Commotion and is not the Effect of Pressure
As I have seen several Instances from a fall
a Person shall Receive an External Injury upon
the Head, but having when falling been in such 
a Position as when sitting has Given such
a Shock to the Brain, that has been follow'd by 
such Symptoms as that Death, has often
been the Consequence, the Patient becomes
Irrational, frequent Bleedings wth. Opening
Medicines should be made Use of 

for the Operation, all You can do is to Procure
Evacuations wth. regards to Wounds Inflicted on the 
Meninges they should be treated, in such a Manner
as will best tend to Prevent Inflamation; It remains
now to Tell You the Certain Place for Performing
the Operation, You are Justly Forbid to Perforate the 
Skull on the lower Part of the Os Frontis; On Account
of the Frontal Sinuses's, Another Part in which We
are forbid by Writers is the Posterior Part of the 
Os. Occipitis, the Os Temporum, is another Part to
hear of Dividing the Temporal Muscle, but those 
Writers Consider'd not that it was impossible to 
Perforate the greatest Part of the Parietal Bone,
without the Previous Division of that Muscle and 
its Tendon, Another Cause of Fear was the Division
of the Artery, the Locked Jaw is a Local Disease
and do's not Arise as some Imagine from a Division
of that Muscle, Our Forefathers forbid the 
Perforation on the Sutures, Supposing the 
Hemorrhage would be so great as to Prove 
Dangerous; I by no means Recommend the 
Perforating the Sutures where You can Avoid it.
I doe not Mention it as I would have You
Guilty of Rashness, but to Show You the 

Longitudinal as any other Sinus may be 
Punctured, without that Danger or Ill Consequence
Arising from it, I once Purposely open'd the 
Longitudinal Sinus of a Woman I hapen'd which 
instead of Producing any ill Effect rather Gave
Releiff. A Caries of the Cranium sometimes
happens and is Produc'd from Two Causes, the 
one is from External Violence, and the other is from
the Lues Veneras About ten Years ago an Elderly
Man was Riding in his Coach, was by a sudden
Joilt thrown from his Seat, and Struck his Head
against an Iron which was fasten'd at the top of 
the Coach, he felt at that Instant an Acute Pain 
but it soon Went off. Sometime after I saw him,
and found his Head in an Erisepellatous State
there was a small Wound, and upon Examining 
I found the Bone rough; and to my great
Surprize Reced'd from My Fingers, which 
immediately Gave him immense Pain, I Remov'd the 
Carious Part and then soon became Well. In a Venereal
Cause they likewise become Carious when the Disease
when the Disease in the soft Parts. A Mercurial
Process is Useful, but the Moment it Cease to but

as a Medicine it becomes a Poison. I have been an Eye
Witness to this in Numberless Cases, when the hard
Parts are Attach'd You must have a suppuration, and this 
is only to be Effect'd by a Nourishing Diet, and where 
it may be proper to make use of the Hard Recruit.--

Lecture 12th.
On the Fistula Lacrymalis.
The Subject of this Lecture is Commonly, tho
improperly Call'd the Fistula Lacrymalis, there
is no Disease wth. which the Human Body is Affect'd
has Caused a more Variety of different Opinions
amongst Writers than this has done; the Ancients
where very Erroneous in their Method of treatment,
their first great Cause of Error is their having 
mistaken one Part for another, they likewise
being Unacquainted wth. the Part where the 
Lacrymal Fluid was Secret'd; you will find both 
amongst Ancient and Modern Writers a Variety
of Opinions about the Seat or Lodgement
of this Fluid, their Descriptions are Inaccurate
they where of an Opinion that the Caruncle
became and In Cyst'd Tumour, but they all
Agree in this Point that of an Induration
and Caries of the Bone according to their 
different Opinions, so likewise they differ in their   

Manner of Treatment, they who Imagin'd the Diffusion
more from Inflamation and endeavor'd to suppurate
the Carunculi others by making an Incision to the 
Carunculi in Order to Eradicate it, and others
made Use of Ecsharotic Applications, Whoever
Treats it in this Manner can never succeed in his 
Intention, by Irritation it is Certain You encrease
the Disease, Vision could not be Perform'd
wth. that Facility it now is unless the Surface of 
the Coats where Kept Continually Moist, and free
from Dust or from any Irritating Body, the 
Lacrymal Glands Serve for keeping the Tunicæ
Cornea Moist, and bright and to Remove
any Dust from this Coat, when by Accident
they are Stimulated either by the Passions
of the Mind, or by any Extraneous Bodies, the 
Lacrymal Fluid becomes so much increased, as 
to Run down the Cheeks, it is then Call'd the 
Tears, when the Disease Exists, it is sometimes
so Avid as to Occasion Excoriation, of the Skin
the Quantity of Fluid is not Known, the 
Lacrymal Sac is Situat'd in the Ductus Nasalis

which Opens into the Nose, behind the Os Spongiosa
Inferiora, the inner surface of this Duct is Besmeared
wth a Fluid to Prevent any Irritation. The Fluid
Devis'd from the Lacrymal Gland is Facilitated
by the Motion of its Lids, is Receiv'd by the 
two Puncta Lacrymalis and then Convey'd into
the Sac, those who Labour under this Disease
from what Cause so ever it may Arise have this 
Sac Obstruct'd, the Consequence of this is the 
Tears run Down the Cheeks, this Disease as 
its Origin from a Variety of Causes. In the 
beginning from improper Treatment sometimes
after the small, Rose, or from the Mucus Membrane
which the Lacrymal Sac being Obstruct'd.
The Moderns Say that this Disease in its
first State Arises from a Lodgement of the 
Lacrymal Fluid, all Obstructions of the Fluids
when Lodged become very Hurtful. Its Colour
Depends on the longer or shorter Existance of the 
Disease, so do's the Colour Change. It has been 
Improperly Calld Pus, as I Mentioned before,
It Arises from a Variety of Circumsances and 
is Attend'd wth. such as Form Obstruction in the 

Nasal Duct, If by ill Treatment the Bones should
become Carious, as sometimes happens from the 
Pore Polypus or Cancer, so according to the Disease
and other Circumstances, You are in a great Measure
to be Guid'd, in the Manner of Treatment, or other Means
You are Oblig'd to make an Opening for the Discharge
of the Fluids, some of the French make Use of a Syringe
to Inject the Sac. If it will Pass from the Lacrymal
Sac into the Nose it may doe, but whoever will
View the Syringe and Probe they make Use of will
See the Impractability of the Operation, Compress and 
Bandage have sometimes been made Use of wth. Success, but 
then this Pressure must be in such a Manner upon the 
Bay as will Remove the Obstruction, and avoid
giving Irritation, I have tryed that Invention of Mr Sharp's
but is Proves Ineffectual, You will find in the 
memoirs of the Royal Academy at Paris, a Variety
of Methods for to Remove the Disease, there Two 
Methods now Observ'd, the one I think very Rational
the other rational Method I recommend to You 
is this, by making an Incision into the Duct and Passing
the Knife in such a Manner as not to Injure the 
other Parts, having made Your Incision, You are then 

to Apply Lint, in such a Manner as to Preserve
Your Opening, and then gradually Dilate it by a 
Piece of Spunge or Bougie, or a Piece of Lead,
which must be Introduc'd to Pass the Nasal Duct
and thereby gradually Dilating the Opening, a Cure
will be Effect'd; the Tent must remain in Three
or Four Months least the Disease should be Renewed
the Scar by these Means will become very simple
this Disease is often very difficult to Cure, but its often
Owing to their going on Dilating and Causing
Inflamation, which ought always to be particularly
Avoid'd, all Kinds of Bandages or Pressing Bodi's 
are Prejudicial; I am now to Inform You of the 
best Method of making a New Channel, when either
by this Treatment or any other Cause it is so Obstruct'd
and not to be Remov'd. The Ancients made Use 
of the Caustic and Terebra, when we doe it We only
Mean to Perforate into the Nose, the most frequent
Method for this Purpose till Lately was the Cautery;
Mr Chapaldon Stands first for the Inventing and 
making Use of this for the Removal of this Diseae;
I have Seen many Disagreable Effects Arising from it 

for in Spite of all Your Efforts to the Contrary You will
Destroy the Neighbouring Parts, which most Certainly
You ought to Avoid doing; For the Purpose of 
making this Opening, there is a much better
Contrived Instrument, the Curv'd Trocar, when You 
have made Your Perforation, which You will Know
by Blood Passing through the Nose, then Apply
Your Tent of Lint, and then some Drawn Lead to 
Maintain the Opening taking Care to Avoid
giving Cause to Inflamation, and lastly not 
to Remove Your Tent till the Time above Mentioned. 

Lecture 13th.
On the Cataract.
The Eye Consists of Three Coats, tho there are 
some who have made five. It has likewise the 
Humours. The Tunica Sclerotica, the Tunica Cornea
which is Transparent, and the Tunica Retina, wn.
The Tunica Ubia and Iris; the Humours are the 
Aqueous which is the Anterior, the Chrystalline
and Vitreous, which are situated Posteriorly,
the Diseas's of which I am now to Speak have been
much Misrepresented, by Writers, it has been Supposed
as Consisting of a Variety of Circumstances, it has 
however one Plain Disease, It is an Opacity
of the Chrystalline Lens by Vision is Variously
Imped'd or wholy, Destroy'd, it Varies in its 
Appeance and Colour (Viz) of the Pearl Blue
Brown &c, the general Doctrine in regard to this 
has been that at first when the Disease has made 
a small Progress, it was then Immature; but as 
the Disease increased it then became Mature 

and fit for the Operation. That this Doctrine is not 
always true is very Certain, I have several Times seen where 
from a Blow being Receiv'd, the Chrystalline Lens becomes
immediately Opake; Again I have seen where the 
Cataract her remain'd in a Fluid State all the Time
The Disease has Exist'd, therefore the Shortness of 
the Time making it Mature or Immature, is Uncertain
I have seen the Chrystalline of a Living Animal as 
Capable of Resisting as in the Dead Body, the 
Dissolving of the Chrystalline Humour is Proceeded
by a Pain of the Head, in those that appear
While and Indurate is sometimes the Effect of 
Age, there are some Circumstances which Determine
the Event of the Cure. If the Patient and 
Opake Chrystalline can Perceive the Light there
is scare Hopes of Success, but if the Patient
cannot Discern the Light there is a little more.
Besides the Dissolved and Indurated Cataract
there is Another which has been Term'd the sheting 
Cataract, another Circumstances which shoud be 
Consider'd is the Mobility of the Papillae, which 
if immovable is very Favourable, but if not the 
Operation should not be Attempted, If You Look 
into Books You will find a Variety of different 

Methods for Performing the Operation, the Disease
in its Cure is simply, there are two Methods of 
Operating now in Use, one by Depression of the 
Chrystalline Lens which is the Oldest Method, the 
other is by 3 Extraction; the Latter took its Rise
from Accident as many other Improvements
in Surgery have done, to Extract the Chrystalline
Lens You make a Transverse Incision on the 
Cornea a taking Care not to Injure the Eyes when 
its Coats Unite, by this Means You will Preserve
the other Humours from falling out, in Order to 
Depress the Chrystalline Lens, You Pass
Your Needle in the same Manner, but Pass Your
needle into the Posterior Chamber of the 
Aqueous Humour, You are then to Turn Your
needle breaking Down the Cataract, and when the 
Papilla becomes Clear, You are to Depress it,
sometimes it will rise again on the Patients
Stooping Down, and again Sink Down on the 
Patient being Erect, sometimes it happens that 
the Division of the Cornea will not Unite, and 
a Quantity of Humour will fall out, the Light
still remains, the best Method I think is that 

by Depression, as You have not so many
Inconveniences Attending it as by that of Extraction
after the Operation a Plaister of Soap Cerate shoud be 
Applied and the Antiphlogistic Regimen follow'd
frequent Bleedings to Prevent Inflamation, and 
if necessary opiates should be Administer'd. 

Lecture 14th.
On the Polypus and Hair Lip
The Polypus Narium is a Disease concerning which both
Ancient and Modern Writers have given very 
different Accounts, wth. regard to the Manner of 
Treatment, but that it was one distinct Disease,
It has however very different Appearances, and 
is Attach'd to different Places, sometimes from 
the Septum Narium, or from the Pituitary
Membrane, sometimes from the Os Spongiesa
or Hanging from a stalk. It is sometimes
Indolent and at other Times Not, and the Bone
to which it is attach'd will sometimes become
Carious, whoever fills himself up wth. Hopes, that
a Polypus will be easily Cured, will find himself
much Deceiv'd. the Cheiff of the Ancient Writers
seem to have been at great Pains, to find out 
some Remedy to stop the Hemorrhage which
they Imagin'd happen'd after every Polypus
was Extracted, and this seems their Grand Object 

in View, but Venture to Lay that those Kind
of Polypus wch. admit of Extraction and are Curable, that 
from these no Hemorrhage will ever Ensue, wch. will Require
Assistance to Stop, I never Saw but one Kind of Polypus
which would Admit of Extraction, or being Cured, More
Kinds of Polypi that are not moveable and are
not differently Affect'd by different Kinds of Weather
and that Put on a Cancerous Appearance, had much
better be Let alone for by Attempting this You
will not Succeed, that Kind of a Polypus, that may 
Admit of a Cure is that which is Movable in Respiration
When the Patient has no Cold it Appears as if 
filld wth. Colour'd, Lymph, and that on taking
Cold becomes troublesome, and in rainy Weather
becomes Enlongated and enlarg'd. If Frosty becomes
less and Contract'd, and on Pressing it a little
Fluid Drops from it, those Polypi which doe
not Answer this Description, will not Admit of 
the Operation; Escharotics which have been made
Use of in this Disease Serve only in My Opinion
to encrease it, some have made Use of Ligatures
but it is difficult to Pass them high enough to the 
Rest, without that You doe not remove the 
Disease; the Polypus is generally Attached to 

the Os Spongiosa; the Method of Extracting
the Polypus is to Pass it up to as near the Root
as possible, a Pair of Forceps wth. Holes in and 
Fall down in a Reight Direction, and not by
Forks, and Hoisting the Forceps and You will
Detach it, It sometimes happens a small Portion
of Bone will Come away wth. it, but to this 
You will Pay little Regard. Those Writers
who Say a Polypus will Grow again, from 
the same Place where the other was Detach'd
have Wrong Ideas. Those which are so much
enlarged as for to Hang Down, and appear
in Sight, either without the Nostril or behind
the Velum Pendulum Palati, are all distinct
Polypi, and that after the Removal, of one error
You shall have another in a short Space.
It has it Attachment at another Part, and 
will Come Down in Consequence of the other 
being Remov'd. 

The Hair Lips
The Hair Lip is of Four Kinds, two of which are Confin'd
to the Lip only, the third is attend'd wh. a Division of the 
Manilla Superior. The Fourth is Attend'd wth. an Horizontal
Protrusion of the Denticular Ridge of the same 
Bone in the first which is only a Simple Division
of the Lip You are to make an Incision on each 
Side so as to Remove the Callous Edges, and Procure
a Speedy Reunion Some have been of an Opinion
that when this Discovers itself at Birth it is much
better to Put off the Operation for a Time, for these 
Reasons Children are apt to Cry, and are apt to 
Endeavour to Remove their Dressings, but these
are very Triffling Objections, for My own Part I never
Object to Performing the Operation, but rather 
prefer it at an early Age; After having Pared
of the the Edges, You are to Introduce Your
Pins and Suture which is the best Method, tho
I have seen the Common Interrupted Suture wth.
Sticking Plaisters doe very well In the Second
You will have two Separate Divisions Opposite
Incision You can not Heal both at the same Time, but
having Perform'd one and suffer'd it to Heal to and [illegible]
the other Under the Division of the Lip You will

sometimes have an Horizontal Protrusion of 
the Maxilla Superior which Comes under the 
Fourth Kind, this must first be Remov'd before You
Attempt the Cure in this Case the Dentes
Incisioi must be Soft, being Oblig'd to Remove
a Portion of the Alveoti sometimes there is a 
Division through the Maxilla; And in this Case
You will Expect to the Benefit; the Impediment
in Speech the Difficulty in Drinking must 
all be Submitted too all You can doe is to 
Unite the Soft Parts, and render the Deformity
less Obvious; The Pins now made Use of are now 
much Improv'd. There Points Screw off which 
Prevents many Inconveniences both to the 
Patient and to the Nurse, which before they 
where greatly liable to.....

Lecture 15th.
On Diseas's of the Trunk
and Thorax.
I shall Divid them into Two Heads, first those that 
happen within the Cavity; and 2d. those that happen
without the Cavity, there within are the Vomica 
Empyema and Hydrops Pestoris, those without are
Wounds and Fractures of the Ribs; Empyema
Cancerous and schirrous Breasts, Wounds on
the external Parts are Triffling, but You must Pay
Attention to Prevent, Inflamation, which is 
Liable to happen, from the Lungs in Respiration
Those Wounds which Penetrate the Cavity of 
the Thorax are Matter of Consequence, they should
be Dressed as Quick as possible, to Prevent the 
external Air, which besides Compressing the 
Lungs, and necessarily Preventing a free
Respiration, will likewise Impede the Circulation
of the Blood, and Stagnating it in the 

Right Auricle. Those Consequences will Arise from 
Wounds Perforating the Cavity of the thorax independent
of any Injury Communicated to the Lungs, and 
which the external Wound Appears largeness
sometimes Unhurt. tho in Perpetual Motion
free Respiration and the Impulse of Blood.
When any Injury was Communicated to the 
Lungs, the Ancients Pronounc'd it Fatal. But they 
are not always so. It Depends upon what Part
they are Wounded; At the lower Part they are 
not so Dangerous, the Ramification of the 
Artery are not so great as they are high up
But the Danger in a great Measure Depends
on the Size of the Wound it may be Raise'd high
up Yet the Patient may Recover. from any 
of the above Mentioned Causes, the Lungs may 
be either Compress'd, or Inflat'd so as to Prove Fatal
by the Blood, Stagnating in the Right Auricle
of the Heart, A Case that I saw a few Years
ago will Prove the none Fatality of a Wound of 

the Lungs; A Boy a Waiter at a Tavern running 
up Stairs hastily wth. some Knives in his Hand
Slip'd Down, the Knives also fell and one of them perpendicular
wth. the Handle of it in a Hole, which the Boy
fell upon, I was Sent for and found a large Wound 
on the Right Side, and from which when a 
Candle was Held to the Part, was immediately
extinguished by the Air returning out.
There was some Hemorrhage, but that Ceas'd to Flow 
of itself it was Drop'd Lightly and Speedily
and the Boy did well, not Attend'd wth. any 
bad Symptoms; there Accidentaly some of the 
Vericulae Airiae was Wound'd on the Surface of the 
Lungs, when the Wound was Exposed he was in 
great Danger then of suffocation; therefore Nature
Led him to Cover it wth. his Hands, which he 
was Obliged to especially in the Night, when by
Accident the Dressings where Unavoidably
Removed, Fractures of the Ribs are Painful
and Troublesome, the Method of Treating them 
is to Kind a Napkin round the Body, Oily 

Medicines, Opiates and the Antiphlogistic Regimen
shou'd be made Use of to Prevent Inflamation, but it
sometimes happens that of spicula of the Fracturd
Ribs will Press through the Pleura and Wound
the Lungs; the air then Rushing into the 
Cavity fills the Tela Cellolosa, when every Part
of the Body which has any Cellular Membrane
will be Distended also and Cause the Disease
Call'd Empyema, the Lungs will Perform
their Office wth. great difficulty and the 
Patient generally Dies of suffocation, and 
non Circulation; Puntures and free Incisions
are Said for to Cure the Labor, I prefer as it 
will give a more and greater Passage to the Air
You are then to make Use of Friction upon the 
Emphysematous Tumours, wth. Your Fingers
which are always to be Oiled to Prevent giving
Pain and Inflamation, Yet Notwithstanding all
this it is mostly Fatal. The Breasts of Women as
liable to many Diseas's; Abscesses are what 

I shall now speak of; they are very frequently
Caus'd by the suppression or Driving Back of the Milk
which Custom Rewards the Intention of Nature,
which is done to Avoid Trouble or Suckling of the 
the Child, or to Avoid Sporting the Shape of the 
Regular Form of the Breast. Woman should be 
Persuaded to Suckle their own Children, as the 
Mothers Milk Purges off the Meconium, and is 
much more Nourishing than that of Another Woman.
As that peculiar Quality which is in the first
and nearest Milk, is here Wanting in the Strangers
Breast; Render by this they will Prevent the Fever
very frequently occasioned by the Stoppage of the 
Milk, and likewise the Causes of Abscess and 
Indurations; these Kinds of Abscess Incident to 
Women, from the above Mentioned Cause have 
been generally ill heated. The Common Method
which hollow'd in the beginnig was to apply
Adhesive Plaisters over the Breast, and where 
a fluctuation was Perceived, there they Apply'd
Caustics, which Methods by Prudent Men 
are never Practised, some make Use of Means to 

Discuss or to make Absorption and a Suppuration
as we have it in our Power to Assist by either of these
Methods to forward Suppuration, You are to 
Attempt by gentle Evacuant, and Emollient
Poultices Continued till it Bursts, as it then
generally makes a more Depending Opening.
Caustics should never be Applied. If it should not 
Burst of itself, a Puncture will become Necessary
which should be made large enough to give free
Passage for the Matter, As by this Means You 
will be Prevented from making Another, Your
Business is to keep the Divid'd Lips of the 
Wound asunder, by this Means You will give
free Passage to the Matter, which is of the 
Utmost Consequence to Your Patient and to Your own
Character some have Imagined that the Matter
has Pointed in such a Manner, as You will not 
be Able to make a free Discharge, from the 
Nipples being in the Way, but they have been
Mistaken, for You may always Avoid
Wounding the Nipple.---- 

Lecture 16th.
On the Schirrous Breast.
Our Forefathers Gave the Name of Shirrous to all Tumours
that would not Admit of Disputation; The Moderns
Term those Schirrous which will not Admit of 
Suppuration and Bears an Affinity to a Cancer
sometimes only one Gland becomes Indurated at others
more and in some the whole Breast, It Appears
sometimes Indolent and not Painful to the Touch
in others it will not Bear the Touch without Giving
Pain. Whenev'r the Nipple is Retracted the 
Schirrous turns Cancerous, and is generally Fatal;
there are two Methods of Cure, the one by Destroying
it by Caustic, the other by Extirpating wth. the 
Knife; The Idea and Dread of Pain given by 
the Knife, has Induc'd many who Labour under
this Disease, to suffer Ignorant People Unacquainted
wth. the True principal of Surgery, to try those 
Pernicious Secrets which they too open Impose
on the Credulous People as Efficacious, they  

Attempted the Removal first be applying Plaisters
for that Purpose, when these fail'd which they 
always will doe, they Apply'd Caustic which 
are very Painful and Uncertain. Tho there is no 
Appearance of a suppuration, Yet the Diseas'd
Part will not be Clear'd from the Sound, the
Pain is greater than that of the Knife, and of 
longer standing. If You apply Your Caustic
too strong You may Injure the sound Parts,
If too Weak it will not Remove the Diseas'd Parts
and it will also by its Irritation encrease it 
and make it much Worse.
The Composition this Caustic generally Consists
of is Meadow Crowhoot Dog fennel Sulph
Vioum and Arsenick, made into a Paste wth.
the Yolk of an Egg, this is in their general Use
and Come from Stevens Hospital in Dublin,
this is their Boasted Secret, and which many
People are tortur'd wth. the Knife is the best 
Remedy if the Operator Knows how to Use
it, and is Acquainted wth. the Seat of the 

Disease, and Anatomy of the Parts, always
Remembering to have as much of the Sound Skin as
Possible. If the Schirrous Gland Lies deep so that there 
shall be some Cellular Membrane and Adipose
Situated between that and the Skin, you must 
make a Longitudinal Incision which will 
sufficiently enable You to Dissect out the Glands
at the same Time Preserve the Skin. The Cancer of the 
Breast has a Variety of Appearances and Appears
under a Variety of Forms, it is sometimes Painful
sometimes Movable, and immoveable, When 
Movable in a favourable Circumstance, it Indicates
there is a Cellular Membrane between it, and the 
Muscles of the Latter it is Unfavourable, and 
should not be Attempted, as the Cellular Membrane
is Indurated, and is Attach'd Firmly to the 
Ribs, a small Degree of Mobility should not 
Deter You from Performing the Operation,
Circumscription is another Circumstance which 
is when the Breast shall be Perfectly Movable
but the Parts of a few Inches round shall be  

Adhering, this also shou'd not be Removed as 
You most likely encrease the Disease
sometimes You will have the Milliary Glands
as large as Grains upon the Breast, this also
shou'd not be Removed, as you most likely
encrease the Disease, and bring on Additional
Pain. Whether the Breast be Ulcerated or not
it should be no Impediment against Your
Exterpating it; If the Pain be very Severe You
should Suspend the Removal of it, so also of 
the Glands in the Axilla or Neck be enlarged or 
Indurated, it is a certain Proof the Disease
Exists in the Habit. I have Mentioned a Variety
of Circumstances which are Prohibitions for 
Performing the Operation; the Prospect of Success
in Those Cancers which Arise from Internal
Injury are greater than those which does not 
as the Latter Indicates a Disease of the Habit.
A Cancer in the Scrotum Attend'd wth. Darting Pain
in the Back is Dissuasive, tho not always a 
Prohibition it sometimes being Local, 

A particular Circumstance to be Observ'd, is the Obstruction
of the Menstrual Discharge, which You should be Careful
to Perform before the Operation; On the other Hand if the 
Menses have Ceas'd to flow, their Bodies will undergoe
so many Changes, that You will have many Difficulties
to Encounter. The Present Method of Operating is this;
the most Painful Part of this Operation as in all 
others is in Dividing the Skin, which tho I am an 
Enemy to Calarity, shoud be done as Quick as 
Possible, You are to make two Semicircular Incisions
round the Breast into the Membrane Adiposa
Dividing Downwards to Dissect it from the Pectoral
Muscle, Leaving it as Bare as Possible, and 
taking Care to Remove all the Diseas'd Parts,
You will have but few Vessels to take up as the 
greatest will Retract themselv's; You shoud then 
Dress it Lightly wth. Dry Lint, and not to Remove
Your Dressings for at least four or Five Days being
Elaps'd, in short untill Suppuration is fully and 
Establish'd, as they will fall off themselv's, You will
then have a Clean Sore. But I am Sorry to Say 

after all Your Care, You will sometimes not 
Succeed, The Sore will have Promising Appearances
and shall Heal Kindly until about the Size 
of a Shilling when its Appearances will Alter,
it will become Glassy and will Spread, it will
Degenerate into a Phagedenic Ulcer and the Patient
will become Hectic and Die.---- 

Lecture 17th.
On the Hydrops Pectoris
The Disease may Arise from Two Causes, when the 
Body is Affected wth. a general Anasarca, and when it 
is Confind solely to the Cavity of the Thorax, the 
Hydrops thoracis is the same Kind of a Disease as 
the Ascites in the Abdomen, they both Arise from 
one and the same Cause, there is a Fluid Constantly
Transuded from the Pleura, which is Constantly
Absorbed; Whenever this Secretion becomes greater
than the Absorption, An Accumulation of the 
Fluid must certainly be the Consequence of it 
and which Causes the Disease; The Symptoms
of this Disease Laid Down by Writers are very 
Erroneous; the Disease may Exist and the 
Patient during Life may Suffer very little, and 
the Cause will not be known till an Opening after
Death. The Symptoms which Indicate the 
Disease are very great Depression and difficulty
in Respiration, especialy upon any encrease
of Exercise by the Lungs being Compress'd the 

Circulation will be Imped'd in some Measure
and the Blood is accumulated in the Right 
Auricle, in an Erect Position the Patient do's not 
Suffer so much, as when he Attempts to Raise
himself or Lay Down hastily, and again he 
becomes Easy by being Kept Quiet, these Observations
will Lead us to Distinguish it from other Diseas's 
when the Lungs are Diseas'd it may be Known 
by the Expectoration, which by this Means generally
Leaves the Patient; the Hydrops Pectoris is external 
to the Lungs, therefore Expectorants will not 
Releive, from the Extravasation of this Fluid,
which should Circulate through the Body;
The Secretion of Urine, becomes less in Quantity
but this is not Specifically in the Hydrops
Pectoris. Another Symptom is the Palpitation
of the Heart, from the irregular Motion of the 
Muscles, and is very Different from that 
Palpitation Arising from ye Spasms. The 
Intermission of the Pulse in this Disease is no 
Uncommon thing, nor is it Specifically Attendant
on it. It has been Apart'd by Writers that You may

Know the Disease, by the fulness of the Chest or on 
one Side, but I never was Able by any such
Appearance to Ascertain the Existence of any such
Disease; where there are certain Indication of this 
Disease, You should not neglect to Perform the 
Operation; a Variety of Methods have been Propos'd 
in Order to Perform this, such as the Introducing
the Trocar in the same Manner, as is done in the 
Ascites in the Abdomen. The Method Recommend
to Your Practise is to make an Incision about 
an Inch and a Half long through the Integuments
between the Sixth and Seventh Ribs Counting
upwards near their Angles doing it very Carefully
to Avoid Wounding the Intercostal Artery; You must
Direct Your Knife, near the Inferior Edge of the 
Superior Rib, You are not to Use the least Pressure
upon the Knife, but Use it wth. the same Caution
as when Performing the Operation for the
Prubonarale, You may then safely Divide the Pleura
the Vomica of the Lungs, this Disease is a Collection
of Matter in the internall Surface of the Lungs
Arising from Inflamation; The Cure of this Disease

is sometimes Effect'd, by the Matter being 
thrown up by the Trachea, tho sometimes it must 
Prove Fatal, by the Quantitey of Matter being so 
great as to Cause Suffocation; In a Collection
of Matter upon the external Surface of the Lungs
or in the Cavity of the Thorax, which some Writers
have Mention may be Known by Ocular Demonstration
have also Mentioned the same Method of Cure as in 
the Hydrops Pectoris.----

Lecture 18th.
On Vomica and Empyema
In all Internall Dises's of the Lungs amongst wch. the 
Vomica is Mentioned, Expectoration always is a 
Salutary Sign, when there is an Accumulation
of Fluid in the thorax, the Disease is Term'd Hydrops
Pectoris, and when the Lungs are Diseas'd Previous
to this Accumulation of Fluid the Symptoms
are different, to what they are when there is no 
Disease in the Lungs, they likewise differ when 
there is Adhesions these Circumstances You
shou'd Carefully Consider; There is another Disease
of the thorax, which generally is not Form'd
until after Death, We never Know when the 
Patient is Living. The Hydrops Pericard the 
Cause of this is the same as sometimes happens
between the Tunica Vaginalis and Body of the 
Testicle, and of the Disease already Mentioned
the Hydrops Pectoris, from too small a Quantity
of this Fluid Secret'd Adhesions take Place, the 
tumor I believe to be a Cause of Sudden Death, and 

in those who have a very Irregular Motion
of the Heart, the Lungs are Liable to many Diseas's
Inflamation Suppuration and Induration and 
frequently Subject to Adhesions, by Previous
Inflamation; the Lungs sometimes become
Suppurat'd; when the Matter is freely Expectorated
it is a Salutory Sign, in regard to that 
Matter which has made its Way through the 
Surface of the Lungs, so as to become Floating
in the thorax, Expectoration can be of no Service
and the only Way to Cure will be by making
an Opening to Discharge the Matter, after
the Method above Prepar'd, but there are no 
certain Symptoms which Indicate this Disease
Occasion'd by a Previous Adhesion of the 
Lungs to the Pleura, the general symptoms
of this Disease is Fever hard Pulse a Dry Cough
Parch'd Skin difficulty of the Breathing wth.
an Incapability of Lying on the Side not Diseas'd
without great Pain. By Means of Adhesion
a Fever Produc'd by so Necessary an Organ 

As the Lungs beine Prevent'd from Performing
an Office, so Necessary to Vitality. In Adhesions
of the Lungs, the Patient find Complains of a 
fixed Pain, so small that he can Cover it with 
his thumb and the Pain is encreased on the 
Patients taken in the Air. Adhesions is follow'd
by Irritation and Inflamation which
which is the Consequence of Suppuration, at this 
Time the external Parts become Load'd, and full and 
this fulness is Circumscrib'd which is the Seat
of the Matter. If the Lungs are Adherent partly
from the Inflamation and Pain; the Patient 
Avoids taking in Air freely; as the Disease encreases
the Matter will make its Way between the Ribs;
the Tumour will Appear somewhat Circumscrib'd
in its Figure it is hard in the Middle and Painful
farther from the Centre it is of the Œdematous
Kind, Joind wth. an Erysepellatous Appearance
as it Proceed. You will Perceive evidently
a Fluctuation, and being Satisfied there is 

Fluid Examine it no more, by this Means You will
Avoid giving Your Patient any Unnecessary Pain
and what is of still greater Consequences and 
happens from Pressure You will have the Tumour
Disappear, and the Matter will be Loose in the
thorax, and will be Attend'd wth. Fatal Consequences.
Your Business is always to forward Suppuration
by keeping the Skin Relax'd wth. Poultices.
There are some who Attempt to forward Suppuration
by Adhesive Plaisters, which only tend to Inflam.
and Irritate the Parts, And in My Opinion ought
to be Let alone, but I know of no Application to 
Assist Suppuration. Nature alone if Left to 
herself is generally sufficient where there is no 
Elevation of Parts, Evacuation wth. the 
Antiphlogistic Regimen becomes Necessary,
But when You have such Symptoms and 
Appearances as shew that Nature is Dispos'd
to Suppurate, You are then to Abstain from 

general Evacuations; when the Fluctuation of 
Matter is felt and the Skin Puts on an Inflammatory
Appearance, You are then wth. Your Lancett to make 
a Puncture, having done this You are to Introduce a 
Probe Pointed Bistory, and make an Opening sufficient
to Discharge the Matter, and then Carefully Attend
to the Habit of the Patient; You are to Apply some 
Lint to the Lips of the Wound to keep them from 
reuniting till the Matter is entirely Discharg'd,
this is sometimes so great as the Patient will
Sink under it. sometimes the Discharge will be 
Continued so long that it will be in Appearance like 
Sanies, it will be Requisite, You shoud apply
a Canula or Use some Means to Reserve the 
Wound Open, taking Care to Avoid all Applications
which Tend to Irritate and Inflame and Nature
will then Compleat her End.----- 







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POTT. L.W.
Lectures on Surgery.
1[8]773-4.

Mr. Potts Surgical Lectures A.D. 73. and 74.

Mr. Potts Lectur/s
on Surgery.
The Introduction
Gentlemen 
My Intention in the following Course of Lectur's
is to treat on the Useful and Important Science
Surgery; and shall not Concern myself in Giving You
a Minute Anatomical Knowledge, or Description
of the Bark; but merely so much as will be hurt
Necessary for our own Purposes, This where I to doe
would be Altering the Plan of My Lectur's; and 
therefore must Defer You to Your Anatomical
Teachers and Books. My Intention is merely to give
you the Practical Parts of Surgery, and which
I shall Endeavour to Say before you, in the most Clear
and Precise Manner that I am Able; some have
Disput'd it being a Science/ others an Art; but it most 
certainly Justly Claims the former. It is needless
to Urge any Encomiums upon on its rise As it is so 
Clear and evident to all Mankind; It was Instruct'd in 
the earliest Times, and different Methods was Pursued
to become the Surgeon; come merely by Perusal

of Books, and Attaind only theory, and there
became by far the Ablest Surgeons in the Closet,
and were apt in Conversation y but in the Practice x
Part where very greatly Deficient, and frequently
at a Loss. And on the other Hand those Introdu'd
by Practise, only wth. the Use of Reasoning or Books,
Labour under an equal Disadvantage, in being
Able to Perform an operation, Dexterously without
perhaps Knowing why it should be done or when it 
is necessary. Different Writers have followed different
Plans, all of which are equaly Defective, and in 
this Particular, they have Confind themselves
in Describing the Modes of Operations merely
wth only wing? You a Clear Account of the Disease,
which requires the operation; they have Given you
the operating Part without Mentioning any Disease
or Prohibitions to any Operation which [Da???]
many Principal Writers [cross out] Labour under; it may
perhaps be Expect'd of Me as is Usualy the Case in
Introductory Lectur's of this Kind, to Give You
an Abstract History of Surgery, which I [cross out] had a 
Power or Capacity to does would Ingross too much of 
that time which I think can be better Employ'd in Parts 

more Beneficialy and Instructive to You; or should 
I do it, it would be only giving You a Series of names
and States. However any one who has Curiosity in him
to Desire to Know this will find the History fully
mention'd in Galens History of Surgery, Clarkes
Surgery; or by Dr friends; the Majority of Writers
have fined a Numerous han of Bandages, and 
Instruments. The first is almost Unnecessary and in
general Prejudicial, nor is is Worth my while to 
Describe them, or Yours to Hear them; the Instruments
are also tedious and Unnecessary, they are very numerous
and an operation was never Perform'd without a great
many of them being Us'd; the Surgeon was never
Imagin'd, unless he produced, or was posses'd and
[illegible] a great number of Instruments; on the 
Contrary I think they cannot be too simple, and
simplicity wth. Respect to Bandages, as well as 
there is always to be Commend'd. There few Bandages
and Instruments which are Useful cannot be too 
Simple, I shall at a proper time Place [crossed out] Describe
them to You; Whoever has the Curiosity to become
Acquaint'd wth. them will find them fully Describ'd
by Scaltehia, and likewise that general Compiler 

of Surgery Neistery this will Instruct You in the 
Choice of Instruments, they are well Described and 
You will find also their Uses. The Methods the 
Teachers of Surgery have follow'd in this. Van
Norn as Divid'd into the ten following Parts, or
Smthutic under which are Dang'd all fractures
Wounds Ulcers and Bruises. The Diabetic; as the
Operation for the hepan, the Eartic or the 
Extraction of Stones, or any rousing Bodies.
The Chartic, as the Extracting of Polypus Excursions,
the Prosthetic, as the Putting in of artificial teeth,
Ey's and Woodan 1 Leg's and Dicorhetic as the 
Management of in Curvat'd Spines. Limbs and 
Clubb feet; and this Plan is regular and very
Superficial, but not at all to be Copied in a Course
of Chirurgical Lectur's. It is Confin'd to the 
Operative Part moraly, a Part very Necessary
to be known, but it Heads not to the Knowledge 
of Diseas's. A Young Man by Studying this method
woud become an Operator, without Knowing why to 
Perform the Operation. He may perhaps doe it when
not necessary Dexterously. First become Clearly
Acquaint'd wth the Nature of the Disease, than where 

the Symptoms shall In. Indicate the operation
and lastly Perform it in the best safest and easiest
Manner as Possible. In Order to render You Capable
to accomplish, thinks may Intention in the following
Course of Lectur's, and which I shall Endeavour to Lay
before You in the most Simple Manner. My Plan
is to make My five or six first Lectur's general,
and to Speak of those Diseas's which are Confin'd
to Particular Parts but are liable to happen in all
Parts of the Body, and having finish'd those begin
wth. the Scalp; and so End regularly wth. the 
Extremities. The Art of Surgery cannot have
too much Said in it Praise, it Unto quite, and 
it Utility, and when properly and Honestly
Practic'd cannot be Deserving of too much Praise.
The Utility of Surgery is well Known to every Rational
Man, Whoever Deflects on the Diseas's liable to be Inflict'd
wth on him, and the Body will immediately on this 
Proposition; Was not the Stone extracted out of the
Irritat'd Bladder what must not evidently have been
the Consequence; On the Contrary the Fracture of a Bone
by proper Position and Assistance of Bandage care,
and Reduction of it may be Accomplished and in 
and in Time the Reunion of the Bone and a Happy Cure.

A Bleeding Vessel, also Point out it Utility, 
for without the immediate assistance of Surgery the 
Patient will Die from the Loss of Blood, the Surgeon
from nearly a fatal End will Restore the Individual,
to his former h Strength, and Health. must more 
might be Said to Elucidate its great Importance are
its Utility. but these Instances Clearly Points it
out, and the best Speaks in Own Praise; Many
People I am Sorry to say it (Consider Surgery under
too different Lights. If Practising only for the 
Sakes of getting a Livelyhood, very little Art
and Abilities are then requir'd, but Considering it as
a great a noble Science it Requires Steady
Applications. Abilities and Integrity; and as You
get this Requisite Acquisition, You will Despise
and Abominate the other; the Surgeon should be well
Acquaint'd wth. Plain [crossed out] Anatomy, that is the Muscular
Parts and especially their Us's, and Simaliar,
when Contract'd and when Relax'd, he shoud under [under???]
the Constitution of every Joint, and the whole of what 
is Call'd the the Animal Œconomy, such as Digestion
from the Mastication of the food, in Passage to the 

Stomach and Stay [illegible] there, and then the formation
of Part of it into the Junction of Bile, and the Conversion
of the food into fœces and Expulsion per Anum, and 
without which he cannot Obtain a Compleat Knowledge
of Surgery. This will Undoubtdly take up some time
it is at the first Difficult, but is easily attaind
by a little Cloose Applicaion, and Perseverance.
A Surgeon shoud not only Know Anatomy but should
have a Competant it Knowledge of Physics and
shoud be very well Acquaint'd wth. the Action and 
Quality of Medicines, As in the Country he cannot 
have the Assistance of Calling in a Physician. A 
Compound Fracture in the first Place will take on Inflamation
and Febrile Symptoms Attending it, which will
Require Medical Assistance, in the last State of it will
from it many Symptoms require a Different and 
Careful Treatment; Surgery not only Consist in Pleuing
the Limb in an Advantageous easy Position or
Dressing or Turning it wth. great neatness and 
Dexterity, this will not Deceive a Patient of his 
Principal Complaints, He may Sink from a Diarrhea
Dysentery or Diabetes, and He must have Medical
Assistance. If therefore Behooves You to be well 

Acquaint'd wth. there the Complaint for the 
Removing of them, or You will kindly annals greatly
Embarrass'd; and from the Meriti that Reputation
which ever Distinguishes a good Surgeon.
Anatomy and Physiology are absolutely necessary
make the Surgeon to there should be added natural
Physiology it ought therefore to from Part of your
Studies, as that will Point out to You the Beauties
which attend the Noble Science, and greatly assists
the natural Genious, and Explains to Us the 
many Divisions Nature sometimes Puts on and
to these must be added, and Temperate Steady
and Resolute Patients Injuring and not Bias'd
by Prejudices, and not to be Led by the first 
appearanc's as Not in Unmanly his Resolution
shoud by no means Lead him to Barbarity or He 
shoud make a Distinction between the Senseless
Dead and Sensible and the [illegible] Irritable
Parts of a Miserable and Unhappy but falling
Patient; thus are the branch in Falling to a Cruelty
in their Operations. Who on reading their Tracing of the 
Spermatic Chord Five or Six Inches up into the Abdomen
for the Removal of Schirrus Testicle and Chord

could ever suppose they ever did it but on an 
Animal Body or that if otherways less than Mad Men
for the Attempt. Now they doe this cannot be Conceiv'd
by a Rational Surgeon, Yet if they Lay this Down 
as a Matter of part, and that have been Produc'd, I can not
Preceive that this has ever been Peform'd but on the 
Dead Body. When a Surgeon Comes in Practise in the
Highest Sphere and is often Calld upon, He must
have other Necessary the Qualifications) An Eye an
Hand and Temper; this Eye is as Gold Pleaser to 
give him, is Hand may if Defective may be Owing 
to himself and his Intemperance; therefore in a 
Surgeon to Live a Temperate Life; His Temper shoud
be mild and be engaging, and not to frighten the 
Irinarous without the Appearance of Brutality
which is always to be command'd, and for a farther
Recital for their a Accomplishment and Necessary
Qualifications belonging to a Surgeon, I will Defer
You to Surgical Writers who have fully treat'd of it,
that a Physician will always be the best Practitioner
who has a a Knowledge of Surgery, and in like Manner the
Surgeon who is the Acquaint'd wth. the Use and Quality
of Medicines, Writers in Surgery may be Divid'd into 
Two Classes those of general System, and those of 

particular Diseas's; the former have not Time enough
to kill as Minute Diseas's they doe little more 
than Give out Lines and Copy from Another; the 
latter You should lead more Attentively, and Pay
always more Respect to Yourself, and Let Your  
own Judgement be always Accompanied wth. this
System Comparing it with Your own Observations,
and Practise Shews to You And then Act accordingly,
Surgery has within these 50 Years been Improv'd very 
much, but Let not that excite Your Vanity, but tend
rather to excite Your Ambition, by Assiduity and
Study farther Improvements, for no Doubt some 
Years hence Our own Successers will be as much 
Astonished at our Ignorance, as We are at our 
Predecesours; Many Useful Improvements, We Owe
to their Use, from wch Fool hardy Practitioners
and Ignorant Quacks; Thus was the Present Later a 
Operation for the Stone, Invent'd by one From Jacques
a Person of no Education. Therefore Knowledge
may be beg of from the Ignorant as well as the Learn'd 

and indeed most of the Useful Discoveries in 
Physick and Surgery have been Effect'd through Ignorance
and Chance. Now Whidaly different is the Small Pox
to what it was a few Years ago, I woud always Have 
in Medicine between the Custom Practise of Religious
well Meaning Practitioners; and the Foolish Variable
Practise of others, nor ever Listen too greedily to 
my sudden New Putting Practise, before You have 
thoroughly Consider'd it; Now with Respect to Your
Studies Compare Your Reading with Your Observations
that You may be able to Form Distinctions and 
Differences, which You may Regulate in Your Notes;
the frequent Dissections of Dead Bodies is absolutely
Necessary, To know the Situation of Parts and 
how Construct'd &c. This will Give You above the 
Rest the sole use of Your Hand in Respect to the 
Operative Part of Surgery, and which cannot be 
Obtaind but by a Dissection. In Performing 
an Operation, always Remember You have a 
Body before You, indeed wth. the greatest Degree
of Sensibility, and wth. the most exquisite healing
therefore Give the least Possible Pain Imaginable

be not too Quick nor Strive to Shew Your
Dexterity, by doing which You may Cut Parts
which ought not to be Cut. but be Calm and 
Let this be a general Rule with You, if its well
done its soon done; I have now only to add, if I shall
Give You any Knowledge in these Lectur's, which
is My Intention to doe; You Oblige me by Improving
it by study and assiduity and then to Practise
as an Honest and Judicious Surgeon- 

Lecture 
On Tumours 1st.
Before the Discovery of the Circulation of the 
Blood and before the general Distinction of the Fluids
through the Body, owing, it was thought the Principal
Fluids where from (viz) Blood, Bile, and Pituatar
and Anobitis, or the Melancholy; and that these when 
and or due Regulation, where not only necessary to, but
even the Source of Health; it was likewise Supposd
that the Redundancy or Dimination of these Fluids
or Numours, was the Cause of Different Kinds of Tumours
Namely Phlegmonous, Erisipelas, Œdema, and 
Schirrhous, that these Opinions are foundd on
Matter of Fact, is hard by necessary to Observe; in
this Place We still keep up the Manner of Distinguishes
Tumours into four Classes, because We find
the Divisions are very natural, and that all four 
Require different Kinds of Cure, the Phlegmond
is not Confin'd to any particular Part of the 
Body, but it may happen any where; Its more or less
a hard Circumsensible & Tumour, it attend'd with [illegible]

Degree of Pain, and Puts on an Inflamatory
Appearance of a higher red Colour, the Patient
has frequently some Degree of Symptomatic Fever and 
commonly is Preced'd by a Slight Shivering in 
Proportion to the Degree of Inflamation; this is the 
common and the most frequent appearance of the 
Phlegmon; but it may from many Circumstances
put on a Variety of Appearances; the Seats of this 
Disease or Tumour is in the Dela Cellulora, or the 
Membrane expanded over or between the Muscles,
for Lubricity, and the Membrana Adiposa, the
former is [illegible] then suppurated; and the 
latter is Partial; so it arises from Obstructing
the Fluids Secret'd by that Membranes, for the 
Lubricity of the Muscles, which it Covers. This
Obstruction Continuing Produces an Induration
which on the Consequence of an Inflamation and 
Suppurating the Phlegmon on Account of the 
Method of Cure is Divid'd to Two Kinds. for were
it is not be Caused by one Previous Disease of the 
Habit, secondly where it is the Normal Termination
of some Disordh of the Habit in general; As for 

Instance the Crisis of a Fever. In the first Place the 
Discussion of the Tumour; should be attempt'd by the 
Antiphlogistic Regimen Emollient Cataplasms and 
gentle Evacuations by the Lancett, and Lenient Purges
and Diluting Medicines; In the Second Place We
ought to Make [cross out] Use of every Method in Our Power; in
Order therefore to Carry of the Disease; for this Effort
of Nature might Prove Dangerous or even fatal, and 
Discussion is to be attempt'd by Means so well and 
generally known, that it would be needless here to Point
it out the same may be Paid wth. regard to be the Methods
to Promote Suppuration, when the Matter is Completely
form'd in the Tumour, thus because the swelling could
not be Dispers'd or because it was thought proper to 
Promote Suppuration, it is undoubtedly to be 
Let out, but the Manner in which this should be done
has been a Matter of most Controversy. Our
Forefathers did it by either Omission or by a Caustic
the latter was more generally Us'd, because by this 
Means the Matter was more Effectually Let out of 
the Abscess; on the Account of the Opening they made
but in this they do not seem to have any great 
Regard to the Pain Occasiond be, this Application

of the Caustic and the Indelible Sear Necessarily
Left behind; when they open'd by the Knife it was 
Customary to Cram the Sore with Lint, afterwards [cross out]
Using not Medicines as they thought Promoted
Suppuration, [illegible] the Contrary when not at all
Calculated for it, by this Means the sore was Surround'd
for a Considerable Space with Inflamation, therefore 
what Contribut'd to the Opening greatly of the Abscess
by Caustic was that there who made use of the 
Knife did by their Erroneous treatment of the Sore 
afterwards; and this then brings their Method into 
Contempt and Disrepute; Incision is much the best
and what I would Recommend to You. This either
making a Puncture or a large Opening wth. a Stroke
of the Knife will Answer the End, You Arrivd at
which is only to Evacuate the Containd Matter, and 
this will always be found the most Useful and Beneficia
to the Surgeon or the Patient they thought that 
the Cavities of [illegible] [illegible] made by the 
Destructing and therefore they thought that they 
where to fill it up again with Flesh and Us'd such

Medicines as they Call'd Suppuratives and
Digestives to Promote this End; the Method Brought on
all those Evils which they Want'd to Avoid. The 
Use of the Caustic they Imagind was a Specific and 
after Leaving the Eucher to Slough off they form'd
the Cavities filled up, and therefore without Considering
the true Reason they Preferd the Caustic, for when the 
Application of Caustic was Us'd they never fill'd the 
Cavity with their Suppurative Medicines Lint &c. He 
is well Known that Matter is Form'd by the Melting Down 
of some Membranous Parts, but this Been a very
small Proportion indeed to the Quantity Form'd of Matter
and Nature herself as soon as the Matter is Let out to 
Contract the Cavity. And We only are to take Care of the 
general Health, and to Maintain such a Opening
as to Present a Judgement of Matter; for the Sear of the 
Matter is often out of the Beast of Our Dressings
and Yet Nature Comes through Abscess as herself. Then
this We find from the filling up the Cavities of Abscesses
with Lint and the Escharotic Dressings was truely
wrong and Prejudicial. And that soon if we where not to 
Apply any Thing the Cavity will be Contract'd.

And upon the whole, We may Allow that the 
Application of a Caustic is hardly even to be Us'd; In
[illegible] simple Phlegmon, the fever generally, Ceases
on the Formation of Matter, but as this do's not always
happen the Assistance of Physic is Necessary; Inflamation
do's not always Terminate in [cross out] either of these two Ways
but sometimes End in Gangrene and Mortification, this 
is generally attend'd wth a Disease of the whole System
when the Habit is Mended and the Gangrene Superficial
Nature herself will Throw it off but when the Part
is entirely Speculated it requires Changes to get 
rid of it, when the Gangrene Succeeds great Pain
and fever &c then We are able to Say the Gangrene
has spread more Internally than what appears 
externally, and if the Operation of Amputation must
be Perform'd higher than the Part Gangrened; and 
the Part Mortified Separates Considerably
above the Discolouration, and is Discharg'd into 
the Cellular Membrane, and always up above
the Mortification. The Operation must not be Stop'd 
before the Mortified Part begins to Separate
for the Mortification can never be Stop'd by an [illegible]
We should above; Attend to the Patients general 

Habit and Counteract such Symptoms as shall at 
the Time Occur, either by Evacuations or the Contrary
and if there is a fair separation Obtaind in 
Consequence of a fair Suppuration Establish'd
this will Point to us the Place where we shoud
Amputate and We should always Wait for this 
not Amputate (as was the Custom of our 
Forefathers, at the Place above for the Reason
of having a good Stump for the additional 
Pain and Consequent Inflamation is very likely
Mortification apart and will often Infallibly
Destroy the Patient; Scarification is thought
to be little more than Scratching the Skin, but 
Gives Pain to no Purpose) If it is meant
to make large and deep Incisions it may 
possiby Discharge a Putrid Lanias and 
Unload the Limb. but it is not Known that
Produces any Sensible Effect. The Erisapelas is 
suppos'd to be Produc'd by Bile it is formd in 
Bilious People and it requires a different 
Treatment from the Phlegmonous. it is commonly
flat and Broad and spreads to a Considerable 
Distance and has not the Scarlet appearance of the 

Phlegmanous and is not so elevat'd or Point'd and 
is generally attend'd with Vesications when large it is 
generally a Disease of the Habit, this Inflamation
may Proceed from Two Causes (viz) either from
too small a Secretion of the Bile, as too great
a Distribution of it, the Causes which may be 
Productive of the Secretion being Imped'd, or 
from an excess of Drinking of Spirituous Liquors
and Debauches of Various Kinds which are the 
Consequence of an Indurat'd Liver for from 
a Salivation, or from a Weakness of the Parts from 
Disease. The Tumour is generally of a Paler
Colour tinged wth a yellow Cast. The Method of 
treating this Disease is to Strengthen the Patient
wth. Cordials Stomachics Medicines Join'd wth. Chalyts
in Order for to Remove the Obstruction and 
to Promote Secretion of Bile, On the Contrary
you must Promote the Suppuration. The other
Kind Arising from an overflowing of the Bile into 
the Stomach Duodenum and Jejunum and is of 
a more yellow Colour. It is generally Accompanied
wth. a fever, there is thirst Amnesty and Nausea
and Inclination for to Vomit and a dislike to food &c.

Neither Dissolves or tends to Suppuration We should
be Careful of the Means Us'd to Dissolve it, when a 
Disease of the Habit, We should Endeavour to Divert
the Bile by Lenient Purges Calculat'd for that 
Purpose, and also to be Careful in Evacuating, wch.
shoud be Done wth. great [illegible]; for it may be translatd
from the external to the Internal Parts, and We ought 
also to attend to the Natural Strength and Pulse
of the Patient, and take Care not to Impede the 
Circulation already began this Method of by
Discussion for ought never to [illegible]
and we are to Promote suppuration when Nature
Seems Inclin'd for to Produce Matter, it is always
to be Encourag'd, there is no method of Discharging
the Matter but by a proper opening of the Matter is not 
then Collect'd in that Circumscrib'd Manner, as in
the Phlegmonous but is left [illegible] in more Places
and the White Cellular Membrane, in a Diseas'd
State and Sloughy two or three or more if necessary 
sometimes the Strength of the Patient is renderd that 
when the Sloughs are separated the Sore has not a 
good appearance. Means the Habit by proper
Medicines and Diet will in good Time enable
Nature to make a Perfect Cure. The Œdematous Tumour

Tumour arises from the Pituitous State of the 
Blood and Juices generally Seat'd in the feet
and Leg's, they are sometimes seat'd in the 
Legs wch. have been Broke, and is Proceeds likew
from an Obstruction in the Absorbant Vessels,
from the Situation of the Leg not being able 
to Perform it Office from time from the Use
of it the Vessels will Receive Elasticity and 
Perform their office, but if it do's not Disappea
the Advice of a Physician is necessary to Remit
the strength of the Patient. The Bark and either
Cordial Medicines Join'd wth. the Chalybeates will be 
found most hope, the Schirrous Tumours. The
Ancient Us'd for to Receive all Indurated Tumours
under this Head but [In?delemus] give that name
taken but that will not admit of Suppuration
by any Means whatev'r; And may justly be Calld
Schirrous or Cancerous, for they are liable to be 
unstated into Cancerous by any slight accident
or a Blow or a Fall, or even the Disposition
or Distraction of a Persons Habit, there are two
Methods Prepar'd for the Removal Extirpation
and Disfaction, the Ancients Recommend'd the 
Caustic as a certain Cure. Duct for my Part

I recommend and Prefer the Knife as I have before done
to your Use; the former is certainly Provid'd you are 
certain of in doing it Business Effectualy, a very
Excruciating Painful Remedy; not let the Patient
who are afflict'd would much sooner suffer the Pain
than Labour to the operation by the Knife and 
Arguments Us'd to Persuade them of the difference
wth regard to the Pain, and the Time of Respiration
is frequently fruitless; the Knife to the Surgeon
who dos [cross out] Know how to Use it, and the Parts he 
is to Cut on, most certainly is Preferable, who 
can Extirpate what he see's is Necessary, and Leave
which is a principal thing as much Skin or will
Collapse and Heal, and having Left but the Remains
of small scar, whereas the Caustic is Productive
of much Pain it totally Darkens the Skin, and what 
is Worse its very apt to doe more in Spite of all
your Efforts to the Contrary; We intend'd to have mentiond or ought
to have done their never has been found was
any Internal Remedy for the Relief of those Tumours
the only one is this Propos'd.----

Lecture 2d. On Wounds
Wounds are by the old Writers Distinguish
into four different Kinds, Incision; Laceration, 
Puncture; and Contusion but in Order to Give you
a more Clear the Idea of them I should Describe
them under the following needs.
Just those which are necessarily Mortal
2d. those which are not in Themselves.- 
Neither Mortal nor hazard one but by Neglect
becomes so; of the first, then are Wounds on the Lungs Near 
Cerebrum, and Medulla Oblongata, Aorta Vena,
Cava Receptaculum Chylic, abd Ductus [Thoracic??]
Those of the Second are the Liver Stomach,
Pancreas and Mesentery, the Spleen and Kidneys,
Those of the Kind Inclind to all Slight Wounds Inflicted
in any Part of the Body; the Method of treatment
and Symptoms attending [cross out] those several Kinds of 
Wounds; of Wound shall omitt until I hear of then
Distinctlly, recent Insis'd Wounds, our first 
Intention must be to Procure a Union of the Divd'd Lips
of the Wounds' I have heard by different Writers
on this Subject several Methods Propos'd and likewise
different Sutures a Description of which you
may see in Kaister and other Authors; the 

Interrupt'd or the Common Suture in those slight
Wounds is the best, Not but the Day one may
sometimes be Judiciously Us'd, as in the Jaw and 
others Parts which are Expos'd, Deformity should be 
Avoid'd: We are Advis'd by French Writers before We
bring the Lips together in Order to Constringe the 
Vessels to Apply a little Allum finely Pulveriz'd or any
other Astringent Powders, but this Method will
certainly Irritate their Intention, by Acquiring a
Suppuration to Cast off the Gramous Blood Clott'd
together by means of the Application, and rendering
the Wound from Healing by the first Intention, which it 
certainly will doe if You Procure the following
Method, after having Examin'd the Wound, and 
found [cross out] of there by any extraneous Bodies, as Dirt &c, which
may have Accidentaly get in to it. You are to
bring the Lips of Wound in to Contact; and in
that Position You are to make Your Suture, and 
Cover it with a Pledget; It is the best Way to make 
a Slip Knot, as You may by that means easily
Remove it, but it sometimes happens from the 
Patient Jandancy to Irritation and Inflamation
that [cross out] these Slight Wounds will be attend'd
wth. much Pain, and Inflamation and some
Degree of fever; [cross out] wch. will require some Attention; 

Our principal Endeavours must be to abate
such Symptoms by Phlebotomy, Lenient
Purges, Opiates, Saline Draught, diluting
Liquids and the Like; and likewise the proper
Position of the Limb or Part of the Body Wound'd.
The Prevailing Practice of London Seems to 
Deny the Use of Sutures thinking them that of Useless
and Painfull Methods; but I do differ from [illegible]
own Experience, there who Decline the Use of Sutures Lay aside 
every Useful and Advantagous Part of the 
Art.-- In Lacerated Wounds it may sometimes
be and if You are Cautious and Say come mention
the Strength and the Situation of the Wound, for 
tho they certainly differ from Incis'd Wounds
yet there are some Inflicted Rarely resembling
them; the same Method is to be Pursued, those
Wounds are generally Attend'd wh agrees Degree
of Inflamation; and such Regime greater
Attention, where in large Wounds of this Kind, tho
there certainly is a less Substance whereby the 
Intention by Means of the suture is Frustrated
yet are of Use in Contracting the size of the Wound,
and in some Degree hasten the Cure; If the 

Wound will not Heal from the Loss of Substance
by this Method, [cross out] Consequence Attending
this Method is Trivial, for it will not add to the 
Inflammation, nor retard the Cure; The Suture will
bring the Lips of the Wound more in Contact
and the proper situation; and half of the Bandag's
You will be able sooner to Compleat a Cure. [cross out]
Wounds made by a Puncture are in themselv's inconsiderable
but are Liable to Prove otherways by the Patient
Constitution, the Inflammation, the Symptoms sometimes
Attending them are very Alarming, A Wound Inflicted
on the tendon of the Biceps Muscle, or any other
We frequently find, is Attend'd with much Pain
Inflammation and Rigidity of the Limb from the
Carelessness of the Patient, and from a strong
Position of the Limb, the Surgeon is to Inquire
how and by what Instrument, it was Inflict'd; And
then Proceed to the Patients Relief; if the Part which
is Affect'd be much Swell'd, and Inflam'd and 
attend'd with some Degree of fever and Pain
keeping the Body Open, the Exhibition of Saline
Draughts and Plenty of Diluting Liquors, VS.
Placing the Limb in a Balanc'd Position and [Apply??]
Emollient Cataplasms should be Continued until 

the Symptoms Abate, but after all these Attempts
Us'd the Symptoms instead of Decreasing Increase
and the Limb threatening a Mortification, the 
Use of the Bark Join'd wth. Cordial Volatile Medicines
Antiseptic Fomentations, Cataplasms are to be 
applied to the Part We may by Rare Means Hope
for Releif, but the Disease still Continuing the 
only Resume will be to Remove the Limb.
Of Contus'd Wounds, Those Call'd Gun Shot Wounds are
the most Violent, and under this Head it was the 
Prevailing Opinion, that no Person who had
not been Abroad, And Attend'd Wounds of this Nature
ought not to Presume and indeed were Deem'd 
Incapable of giving any Releif to the 
Patient; the Ancients Support'd that the 
Powder and the Materials wth. which the Wound
was Inflict'd Carried with them a Poisonous
Quality; from this Erroneous Positions, and being
Influenc'd by this Opinion they Treat'd the 
Patient directly Contrary to the Method I shall
Relate in Order to Guard against the Poisonous
Body they Administerd high Cordial [illegible]
Medicines and Aromatic Fomentations by which 

Means they encreased every Symptom of the fever,
Tension and Inflamation, The Practise I make Use
off in the Cure of these Kinds afterwards in the 
following, having Inquir'd wth. what Kind of fire Arms
they were Wound'd or the Wound Inflict'd, and in what 
Position the Patient was in at the time, and likewise
what the Peice was Load'd wth. You are then Carefully
to Extract the extraneous Bodies there in Lodg'd
but in these Wounds tho they have admitt'd
a Bullett, the Muscular fibres from the Irritation
it Causes generally a Contraction, and You will
Scarce be Able to see the Parts were it Enter'd.
In this Case it will be proper to enlarge the Wound,
if the Part will Permit, which You will be able
to Judge from its Situation, and with the Help
of a Pair of Forceps Extract it; but it happens sometimes
that it Enters so Violently, that it may by making 
an opening be much sooner and easier Extracted
on the Contrary Side almost through the Limb; having
Cleaned it as much as Possible the next thing
Propos'd is Dressing, which must be very Softend
Lenient; and entirely freed from any Irritating
Quality, the Digestion, the Balsam of Bartholomeus
Hospital Applied to the Wound and Covered
with some Warm and Relaxing Cataplasm
will Prove.-- 

Serviceable, and must be Continued some time; there
must be also some Attention Paid to the Inflammation
which must be by, Bleeding largely, Glysters
Given Occasionaly, with Plenty of Diluting Liquors,
Observing a Low Regimen, and not forgetting
Opiates to Appear the Pain; after a Plentiful
Suppuration Comes on, The Bark may be 
Prescrib'd wth. Success. If any of the Vessels
should be Divid'd You must first take Care to Secure them
by a Ligature before You Attempt any 
Application, a great deal has been Said
Concerning the Method of Stopping Hemorrhages
there has been Four Methods Prepar'd (Viz) by Pressure
Stypticks of Various Kinds, the Needles, and 
Ligatures, and by the Cautery, in some 
Cases Pressure may doe very well and 
certainly do's when it is gently Us'd, but 
it is too often apt to Occasion Mortification
by a too Strong and Continued a Pressure;
Styptics may sometimes be of Service, those 
of the Escharotic or Corrosive Kind are Prejudicial
and ought never to be Us'd in small Bleedings
I have made a tincture of Gall Nuts in the 

Rectified Spirits of Wine, and Balsam Fraumat
which has been very Efficacious; the Needles and Ligatures
are by far the best, and inert Method; and what 
I would Recommend to Your Practise, always
take up the Vessels as Naked as you can. And
never Include the surrounding Cellular Membrane
for as that begins to Suppurate, the Ligature
becomes Loose, the Artery will again Dilate and 
You will have a fast Hemorrhage [cross out], which will
now perhaps be very difficult to stop. As by the 
Last Method by the Cautery it is too extremely
Painful and highly [cross out] Unnecessary, and that is 
now Universally Explod'd. 

Lecture 3.
On Fractures
Fractures are by Surgeons both Ancient and Modern
Divid'd into two Kinds', Simple and Compound; what
is Meant by the Simple Fractures is when there 
is a Division of one or more of Bone or Bones,
without any external Wound; And a Compound
Fracture is a Division of Bones, and a Wound
Occasioned by the Protrusion of the End of 
such Fractured Bones; I shall in this Lecture
only treat of Simple Fractures. A Simple
Fracture may be Caused by Various Accidents
as Falls Blows, and which by proper
treatment and Care may easily be Reduced
and Cured; Our Predecessors where of Opinion
that Broken Bones coud not be properly
Reduc'd unless an Extension was made, that would
force the Resisting Muscles, and bring the Ends
of it in a Straight Line, but seperate but afterwards
Suffer'd it to Come into Contact by gradually Relaxing 
the Muscles, this was their general Opinion and 
as such Put in Practise. After having by Extension

and Counter Extension having Plac'd the Ends of the 
Bones in Contact, the Assistants who are Direct'd to keep
it in that the Extend'd Situation, till the Bandage
Plaisters and other Necessary Applications where made;
the Surgeon then having Felt the Ends of the Fracture
wth. one Hand, and gradually applying an Adhesive
Plaister wth. the other, which they thought woud
Act as a Discutient. Next to this they Us'd to 
Apply the Circular Bandage, and to that where 
Plac'd Four Splints, which where made very 
short, to Answer the Purpose as they thought of 
keeping the Ends of the Bone even, and in Contact
and Lastly after every Kind of Compress, a Banadge
as they thought Necessary for the Security of the 
Limb was Applied, and it was rest'd in this Extend'd
Position in a Fracture Bone, made of Wood whose
bottom Lies in a direct Plain. wth. sides to Prevent
the Clothes from Pressing it. As I have Now given 
You a Description of Our Forefathers Practise,
and which I am Sorry to Say it, is still Continued
by some. I shall take the Liberty of Relating 
it to You, the most Safe and Effectual Method
of Reducing and of treating Fractures whether
of the Leg or thigh. Having Put Your Patient 

to Bed and Prepared Your Apparatus which 
are a Pillow and Eighteen taild Bandages a Flir
of Plaister Tapes and Cradle; You are to Place
the Leg so as to have it in a Balanc'd Position
upon the Pillow; and if from Placing it thus the 
Ends of the Bones are not in Contact, which 
generally You may wth. very little Extension
Replace them, this done You are to Apply Your
Plaister on it, the Bandage, and treat the Splints,
which must be only two in Number, and Long
enough to Serve both Joints, which is the Intention
Meant by them; these are to be Lined with [??w] or 
any other Soft Substance, to hinder the Pressure 
on the internal Malleolus or external Condyle
then Secure the Limb in the Pillow by tapes
around to Place over it to Prevent the Pressure
of the Bed Clothes Your Cradle. It will be 
proper to Bleed Your Patient and if Costive
Order him a a Glyster, the Advantage Arising
from this Kind of Treatment is Obvious;
Placing it in a Relax'd Position certainly
Prevents Tension, and Inflamation; and the 
Muscles are thereby hinderd from Acting. The
Plaister which should be applied shoud be of the 

Repellant Kind, much as the Carat Sapon of
Bartholomews Hospital or the Application of the 
White of Egg's and Acct. Spirits of Wine alone or 
Mined wth. Vinegar and Spiritus Minder; all these
are very proper and much more so than the Applications
they Us'd, which where Exp. Robor; Piris; which are apt
to bring are a Necpes and Cause Violent Itching.
The Bandages he recommends are certainly
very advantageous, As it do's not require the 
Disturbance of the the Limb, which the Roller
do's and must Impede the Formation of Callous,
And this Position of the Limb will Admit of the 
Applying of Cataplasms, full as well as the 
other. The Splints are Mentioned before, and must 
be large enough to Secure and keep Steady
both Joints, and may be fasten'd in the Manner
Propos'd; and You must likewise Pay some
little Attention to the Situation of the foot.
Taking Care sufficiently to keep the Bone Level.
This Method strictly Observ'd will have the 
Desird Effect.---  

Lecture 4th.
On Fractures Continued.
Having in some Method Describ'd to You the treatment
of Simple Fractures and the Applications proper
to be Us'd. I shall now relate a few particulars
on each Bone. If the Clavicle be Fractur'd We
are Ordered by our Ancestors to make a sufficient
Compress on the rising Ends of the Bones so as to 
Depress it, and bring the rising Ends of the Bone in 
Contact wth. the Inferior End. but this Doctrine
is Absur'd, Erroneous, and Impracticable; for 
were You to Press ever so great a Weight upon
it, You might Crush the Bone; but would never
answer Your Intention. in Depressing it.
The Clavicle is fix'd to the Sternum and Scapula
by a Ligamentous. Articulation for keeping
at a proper; Distance the Scapula from
the Body; thus when Fractur'd it is always 
Depressed at the End Articulat'd to the 
Scapula from the Weight of the Stone falling
inwards its evident that the former Practise
is Erroneous, and that which they form the 
Chiding End is truely on its Place the 

the only Method of bringing the two Ends into Contact
is to Elevate the Arm until You find the surface of 
the Bone even, then to Apply a Plaister of [illegible]. Supor
wth a small Compress of tow, Securing it by a 
Bandage wch. is to Crop the Bark and Breast
in such a Manner as to keep the Shoulders Back
and Breast as much as can be allow'd of for the case of Your
Patient not forgetting to keep your Patient arm
Elevat'd without which Your other Applications
are fruitless. In the Inactiv'd Tumours; for the 
Reduction of which You are to Relax the Muscle
of the fore Arm, or they will Prevent the Antagonist
and translate your the Intentions, tho You should
Use great Extension, to bring the Ends of the Bone
in Contact; the Method of Reducing it is this 
is to Bend the Arm Setting the Patients Palm
of his Hand be on the Breast. And then if Requir'd
make Your Extension, then Applying Your Cerate
and Bandage either the Eighteen Tailed or Circular
keeping the Arm in the same Position. In a Fracture
of the Arm or, of the fore Arm either of the Ulnar the 
Radius, We are to Consider that We have not
only the Muscles which Perform Flexion and 
Extension, but Pronation and Supination,

and therefore the Arm must be so Situat'd as 
to give these Muscles no Cause to act, having
Relax'd the Muscles by Placing it on the 
Patients' Side, and Rending; You are to
Remember) to place the Patients Radius
upwards, to Place the Palm of the Hand to 
the Patients Breast. and make whole extension
may be Required. after that Apply Your Cerate
Bandage and Splints, Placing it in a Pillow
Secur'd by a Sling in Order to keep the Arm in 
the Direct'd Position. In the Fractur'd Femur
having Put Your Patient to Bed, and Plac'd
him in an easy Position on the Side which
the Fracture is, You are than by Relaxing the 
Muscles of the Leg, to Lay it in an Oblique
Position, And in that Manner make Your
Extension, having got at the End of the Bone
in Contact, You are to Apply Your Bandage
and taking Care to Place the Knee in such
an Elevated Position, as will keep them
in Contact. For a Fracturd Tiberias Tibula
the Leg is to be Plac'd in the same Relax'd
Position, as is above Mentioned. But it sometime
happens there will be a Fracture of the Tibula

wth a Dislocation of the Tibia. which is a Case which
her Perplex'd Our Ancestors much. And by their ill
Treatment made them liable to very Disagreeable
Consequences. Having [cross out] Seen several wth.
very Alarming Symptoms, they Us'd to Place
the Limb in an Extend'd Position, and as they Laid 
Reduce the Dislocation, by making a most Violent
Extension, which was the Practise and wch. is ever to be Condemned,
all that is to be done in this Case is to Lay the 
Limb in such a Position as for a Fractured
Leg, by that Means You Relax the Muscles
and Ligaments Surrounding the Joints, and 
in a great Measure Replace the Mallastus 
Internus which was thrown outward. In this Case
the Tibia is thrown off the Astragalus and the 
Ligaments are Lacerated; but by this 
Method, And Attending to the Symptoms
and Positions, You may Promise Yourself
a Happy Cure. There are Two Fractures in 
the Human Body which Require the Limb 
to be Placed in an forehand'd Position, which 
are these a fracture of the Olcranon and 
the Patella, the Position keeping the Ends
more in Contact, than in a Relax'd or Bent one
[illegible] than Extend'd either the Arm or Leg 

You are to Apply Your Cerate, and Circular
Bandage, Keeping Your Patient at Rest. It
sometimes happens but from what I know 
not or cannot Determine whether its either from too small
a Quantity of the Ossifying Matters or the 
Patients Constitution, that after the Patient
has Kept his Bed for Six Weeks or Two
Months, that the Bone will not be firmd
have Seen this Twice or Thrice in the Os
of the Humeri more in that Bone than in 
any other in the Body. If this should happen
the Method I should advise, and which I have 
found most Useful /is this/ to Let the 
Limb Hang in a Depending Posture for about
the space of an Hour, and to Mind the 
Patients Habit by the ordering of Cost Peruv.
The Relax'd one or Two Cases when the Callus
in a Carinate Patient Produc'd a Caries of the 
Bone, and Loss of the Limb, and when the 
Limb was Remov'd the Cancerous Veins
Attack'd the Viscera, and the Patient Died.
In all Fractures there is a Symptomatic
Fever more or less and some Degree of Tension
according to the Habit of the Patient; You
are to Attend to those Symptoms, and Obviate them

by such Evacuations as You shall Judge necessary
in Pletheric People, You will sometimes have 
a Violent Tension, and Inflamation; and in
Gouty Patients, very often a Violent F.H. which
is a very Disagreeable Circumstance. In all these
Concomitant Symptoms You must Pay the 
Utmost Attention, and make Use of such means
as will be most Productive of Your Patients
Safety, And Your own Reputation. In the
first the Antiphlogistic Regimen will Answer
Your Intentions; In the Second Medicines
and Fomentations Calculat'd for such Disorders
and to Divert the Symptoms attending it.

Lecture 5th.
On Compound Fractures
A Compound Fracture is Produc'd by the Protrusion
of the End of the Broken Bone, through the 
Integuments Covering it, Causing a Wound, whether
large or Small, I shall first treat of one which Requires
very Judicious Treatment, which every honest Man
would Exert his Judgement to Know whether such a 
Limb is Capable of being Sav'd without hazarding the 
Patients Life. In a Fracture, where the Bones are
Broken very Obliquely and at the same Time Protrudes
so as far as to Put it out the Surgeons Power
to Reduce it. Join'd at the same time with a 
Violent Laceration of the Parts; in such a Case
undoubtedly the Operation will be Necessary.
It is impossible for the most Experienced 
Practitioner to Determine whether such a Limb
may not be, but it is certainly most Prudent
to Remove the Limb, in these Circumstances
You run a Hazard of Your Patients Life, for 
in this Case there is no time to be Lost, from the 
Circumstances of the Case must be Urgent.
The Symptomatic Fever must be great and an 

Impediment to the Circulation must be the Consequence
from the Laceration. The Second Case is when the Bones bear
much Crushed or Broken and the Surrounding Parts
so much Build by the Weight, as to Put an End
to the Circulation; this as well as the other will Require
the Operation. The third Case which will Require
the Operation, in having Attempted to Save the Limb.
The Inflamation Notwithstanding You have made Use
of every proper Method, so as to bring on a Gangrene
and then Mortification. Remember this Circumstance
that if You have not Removed the Limb before the 
Mortification has began to Spread; and that Removing
while Spread it will Destroy the Patient, as it will
by no Means a Stop the Putrid Virus, therefore
it behoves every Person to Assist Nature, by such 
Means as will Cause a Separation of the Diseas'd
Parts. The Symptoms Arising on the first Case
are. If the Limb is not Remov'd in a very short
Space of Time, Violent Symptomatic Fever Attend'd
wth. thirst a Parch'd Brown Tongue, and very frequently
a Diarrhea. The Limb at the same Time in an 
Inflammatory State, these symptoms may Continue
two or three Days and then instead of Inflamation
the Limb will Put on a speculated] Appearance 

the Fever is then increased and Attend'd with 
a Singulous and with a Delirium, and frequently
Fetid Stools and wth. Colliquative Sweats, and Death
inevitably the Consequence, An Instance of this Kind
I lately Saw in the Hospital. Where the Tibia
and Fibula where much Broken and the former
Protrud'd, and so much as made it Impossible to 
Reduce it Mr Pitt advis'd the Man to Submit to the 
Operation, but he absolutely Refusing at the 
End of four Days he Died, in the above
Described Symptoms, frequent Bleeding was 
made Use off. and likewise Lenient Purges and 
Glysters so as to keep the Body Open and 
and Abate the the Inflamation; the Bark was 
Administer'd, [cross out] when the Limb Put on the 
Sphacelat'd Apperance. The Volatile juleps
was Join'd wth. it. The Limb was Foment'd with
the Aromatic Fomentation, And a Poultice of 
Wine Les was Applied and Oatmeal. The 
Symptom from the Second will be the same but 
whether they will be so evident soon, I cannot 
Say; but it is very Evident that a Limb
Join'd and Bruised in such a Manner will not 

Admit of the Reunion of the Pieces of Bone, nor 
can We ever Expect the Circulation to be Carried on,
If not the Hemegnance must be from Gangrene and End 
in Mortification, which will have its Concomitant
Symptom's and Destroy the Patient as in the 
preceeding Case, the Method Us'd must be the 
same. And if the Pain is Violent in either Case Opium
must be Employ'd and wth. Success. In the 
Third Case when the Limb has gone on for some Time 
favorably by the Methods which have been
Us'd, it will sometimes happen from the 
Natural Tendency of the Patients Habit, that the 
Inflammatory Symptoms will Return wth more 
Violence than at the first, and all future Attention
will Prove Fruitless. Its still increasing the Limb Put
on a Gangrenous, Appearance, and at Length
Mortification; then it will be Necessary to Assist
Nature in Separating the Morbid Part from the 
Sound Parts, by the free Use of the Cortex, Join'd wth. Aromatic
Medicines; If You can by this Means so far keep up
the Vis Vitae, so as to Cast off the Morbid Parts, and find
You have Stop'd in Progress, than the Operation
will be Necessary on that Part of the Limb it is to 
to be made, the situation of the Parts will Determine 

having treatd on those Fractures which will Require
these Operation shall Relax a few Particulars
on those Symptoms which are more Lenient
We will Suppose a Compound Fracture Caus's 
a small Protrusion of the Ends of the Bone,
And Attend'd which is sometimes the Case wth.
a great Degree of Tension, and Inflamation; all
that is Requir'd is to apply a Pledgit of Cerate,
and the same apparatus as in the Simple
Fractures, but sometimes it happens that the 
same Case, shall be attend'd wth. a great Degree of 
Tension, and Inflamation and Pain, than it will
Require You to Attend Strictly to the Symptoms
and Alleviate them, by such Means as will
Avoid Matter Forming, and hindering the Wound from 
bleeding by the first Intention; To Accomplish this,
Bleeding, the Application of Emolliment Cataplasms;
And if that do's not Answer Your Intention a Weak
Solution of Sal Ammoniac will be proper
likewise Spiritus Minder. Vini Vingear, may
be Applied in the [cross out] [illegible] Cataplasm or after
it has been than Us'd; [cross out] the Inflamation shoud
increase and some Degree of Symptomatic Fever
Attend him repeat'd Bleeding will be proper

If the Pulse will Admit of it, Not Omitting Saline
and Nitrous Medicines. If nevertheless Matter shou'd
be form'd it will be Necessary to Assist Nature, by an 
Emollient Cataplasm, And when a Sufficient Suppuration
in Produc'd to make an Opening in the most Depending 
Part of the Limb; In large Wounds of the Joints, when the 
Capsular Ligaments are Wound'd and a great
Quantity of Synovia is Discharg'd, the Consequences
are generally Inflamation and Gangrene, which render
the Operation Necessary-----

Lecture 6th.
On Luxations
Luxations are Caus'd by Various Accidents, and the 
Knowledge of the Part is Requir'd to be well Understood
in Order for to Qualify a Person to Reduce them.
In Order for to Know this I would Advise You to
Direct the different articulations of the Body
and Pay great Attendance to the thin Ligaments
and Cartilaginous Appendag's there to be longing.
If You are to Remove the Muscles Surrounding the 
Joints the Barral Ligaments woul'd be Joined
in some Incapable of Supporting it in its 
proper Situation, therefore the Origin and Insertion
of the Muscles ought to be Known, and Understood
without which it will be Impossible to Reduce
it wth. ease to Your Patients and Satisfaction
to Yourself. for the Relaxation of the Muscles is 
of Infinite Service in the Reduction.
The Os Humeri may be Dislocated either Inward
Laterally or Downward. it sometimes happens
that the Head of the Bone is thrown under the 
Pectoral Muscle, in the Reduction in this Case
instead of Extending the Arm, and bringing it 

from the Body, You are to keep it near the side and 
Relax the Muscles by Banding the Fore Arm, by that
Means making so great an Extension, as well
bring the Head of the Bone more forward on the Edge
of the Cup and then give Way, and by the least
Elevation of the Bystanders it will immediately
goe into its Place. If the Accident has happen'd
that the Method a Practitioner is able to make the 
off wth. the Hands will not Succeed. I would
Advise you always to Apply Your Towels, or what
ever else You Intend to Use for Your Extension
at the lower End of the Bone, keeping the ForeArm 
Bend'd as by this method all Your Force Applied to
that Bone alone, for if You Apply it as some 
Authors Recommend one Towel on the Luxated
Bone and the other on the Joint below the extend'd.
Force, on the lower is Cast on the Ligaments
which Articulate it to the Luxated Bone they 
Yeild to Extension----- 

Lecture 7th.
On Wounds of the Head.
Whoever will give themselves the Trouble to Reflect on
the Structure and Mechanism of the Cranium and its 
Contents, will Necessarily See the Numerous ill
Consequences, Attending Wounds Inflicted on the 
Head and; Scalp Consists of the Cutis, Tela Cellulosa
Muscular Expansion of the Frontal and Occipital 
Muscles within Tendinous Appendanges, and the 
Pericranium which is Expand'd over the whole
Surface of the Cranium, the Vessels of the 
Internal Pass to Pass through to Anastomose 
wth. the External, If You are Examine the Dura Mater
of those who have suffer'd any Violent Death,
You will find a Number of Bloody Points on the 
Surface of this Membrane, which are the Orifices
of Dilat'd Vessels, I need not mention the 
Treatment of a Simple Wound of the Scalp
as every one knows how to Treat it, but 
it sometimes happens that a great Part of the 
Scalp becomes Detach'd so as to hang Down
like a Flap, this may Arise from the Passage

of a Coach Weal over it; from the Appearance these
Wounds make, It has been the Opinion of some 
to remove the Portion of Flesh should be Remov'd, which Practise
Mr Pott Disapproves off. One Object besides many
others, is that when this Separated Portion of Flesh
is Removed the Patient will never have any 
Pain there Consequently the Patient must ever remain
Bald those Circumstances ought to be Consider'd
therefore the general Doctrine, can Stand upon
no other Foundation, than this where the Suture can 
not be Appli'd, It is very Obvious that all 
Extraneous Bodies, as Dirt &c must be Removed.
If a Suppuration, shou'd happen the Scalp
is by no Means to be Removed on this Account
If Matter be form'd You are wth. Your Lancett
to Let it out, I am of Opinion that a Suture
in most Wounds is best, even when the Scalp
is Lacerated, and the Bone Laid Bare, and 
You should never remove the Scalp except
in one Instance, where You have such Symptoms
as Indicate the Application of the Trephine
than Necessary. It sometimes happens that Puncture
the Skin the Tela Cellulosa, the Aponeurotic

Musclar Expansion and the Pericranium wholly
Injur'd. If the Tela Cellulosa be Wound'd or Injur'd it often
happens the Wound. Puts on a Puffy Appearance
and Vesications Containing a Yellow Colour'd Serum,
there are of the Erisepellatous Kind, and their 
Appearance will sometimes happen in 24 Hours
after the Accident, happen'd it; and will appear
in this Case as if it Proceed'd from some Internal
Cause or Injury but it do's not, although this 
Patient will have such a Nausea at his Stomach
and frequent Vomitings, these Kind of Symptoms
happen in Bilious Habits, it must be Treated
after the Manner of an Erisepellatous Disease
Evacuations by Bleeding Lenient Purges
and Anodyne Poultices, will be found Serviceable
these Cases where well Known, Hippocrates
who Warns the Reader to be Careful in not 
Mistaking this Disease by Supposing it greater
than what it realy is on from some Injury done to 
the Internal Parts. It sometimes happens, that where 
the Muscles and their Tendinous Expansions are 
Wounded whether the Tendons have any Degree of 

Sensibility or not, at this Time I shall not Pretend
to Determine however I am of an Opinion that there 
are Nerves Passing into them, therefore they must have some 
Degree of Sensibility; from Injuries of those Parts You
will have a Tumefaction Come on, And in a Sanguineous
Habit Your Patient will sometimes be Delirious.
This Case highly Requires Evacuations and the 
Pulse will be your best Guide; in the Erisepellatous
Appearances Carefully Attending to the Pulse; If
You make too free wth. Evacuations, and bring the
Pulse below Part, will most assuredly You will
Destroy Your Patient, and You will never have it
in Your Power again to Raise it. I have been Eye
Eye Witness of the many Fatal Consequences Arising
from the ill Treatment of the Disease. There is no 
Disease so liable as this to Translation. An
Inflammation on the Pericranium will Cause it
to be Considerably on the Stretch, it behoves
You here to Divide about two Inches Down to 
the Bone, in the Wounds of the Scalp Fomentation
and Cataplasms, will when there is Inflammation
sometimes Relieve When by an Injury done to 

the Integuments of the Head. The Dura Mater by
Inflamtion becomes Separated; from the Internal Surface
of the Cranium. The Indicating Symptoms of such
Injury as Stupor seldom before the 2, 3 or 5 Day
or even 25 Days from Inflamation and Suppuration
takes Place and the Patients rigors becomes
Exasperated, And in this Case nothing but a 
Perforation will doe, Contusions of the scalp must 
be heal'd by the Discutients; And in all Cases
where there is an Extravasation, be very Cautious
in Prognosticating for it will Appear on the 
touch as if there was a Fracture wth. a Depression
but on the Application of Discutient Remedies
the Disease will frequently Disappear.... 

Lecture 8th.
On Injuries of the Dura Mater.
This Disease was well thrown to Hippocrates who has 
particularly heated of it. I mean to treat of this by 
Mentioning the Injuries, that liable to happen to the 
Dura Mater, from any external Violence on the Integuments
which are always to be Seen in those People who
Die Apoplectic or are Hanged, those Prints which are
then Visible are the Extremities of Lacerated Vessels,
The Dura Mater Serves the same Purpose on the internal
Part of Cranium, and is as Closely attach'd as the 
Pericranium is on the External; If You Perforate
the Cranium of those who Die Apoplectic, You 
will find it difficult to Seperate the Bone from the 
Dura Mater, when from a Fall or Blow a mature
Extravastion shoud happen You will find the 
Extravastion Verge in its Hand and Situation
it sometimes is between the Scull and Dura Mater
at other Times between the Scull and Pericranium
Whenever Situat'd the Symptoms are of Various
Kinds from the most Slight Swooning Down to the most
Comatose State sometimes a Loss of Voluntary
Motion, Hemorrhages from the Nose and Ears 

likewise happen. It sometimes so happens
that the Vessels are so Injur'd as to Cut off all 
Communication between the external Vessels and 
Internal Vessels, Consequently the Circulation must
be Imped'd wherever the Injury is. The Consequence
must be Inflamation and the Vessels put on 
a Sloughy Appearance, Extravasation is 
Caus'd by Detachment of the Vessels, the 
Inflamation then next, Comes on, And the 
Sloughy Appearance Follows, and the Separation
Cast off all, and it Looses its adhesion this
is the Consequence of the Inflamation, You
ought to be well acquaint'd wth. the Manner of 
Distinguishing this Disease, Extravasation is 
Produc'd immediately, and is Symptoms of 
Depression simply, Inflamation is a gradual
Symptom and must be Prevented by Art, When
it happens in the Internal Cavity of the Cranium,
You cannot Know it by the Touch, when externally
you may Distinguish it, When Inflamation
Comes and Matter is Form'd, the Dura Mater begins
to Separate itself from the Cranium; the Pericranium
likewise becomes Separated on the external Surface
there is to be found a Bloody Kind of Tonics

between the Bone and Pericranium, there is also
a Puffiness and a Circumscrib'd Tumour on the external
Part to be found. If in Ten or Fifteen Days Your Patient
should have Loss of sight and other Symptoms. If 
upon Opening the Tumour You a Quantity of Same's
and the Surface of the Bone Put on a Dry appearance.
If Bloody You may take it for Granted, and 
Rest well Satisfied there is Mischeiff underneath
the Cranium We shall Divide the Circumstances
Attending these Accidents, into those Distinct Parts,
The first is (Viz) it very often happens the Blow
shall be such as to have any external Appearance
of Injury, The Patient now has Febrile Symptoms
Come on, Symptoms of Tightness as if a Chord
was bound part, round the Head, has Shiverings
Delirium and Spasms becomes Paralytic and Dies,
this Arises from an Injury between the internal
Surface of Skull and Dura Mater, this Case admits
of no Cure but by a Perforation to Let out the 
Matter, when the Extravasation is externally it 
behaves You to Open the Tumour, and Let 
out the Matter, and now We Consider the Injury
as Attend'd by a Wound, the Blow Given shall
Cause a Seperation of the Scalp, and sometimes
Communicate a Shock to the Vessels, You shall 

Digest the Wound and it shall Put on a favourable [Appeara???]
Appearance, but at the space of a certain Time
he Looses his Appetite, and the Symptoms
happen such as Fever &c; the Wound then immediately
Changes its appearances, the Pericranium will
Seperate for a a Distance round, And You may 
be well assured the Dura Mater is seperated also
and mischeiff is is Forming within the Cranium
the 3d. State is when a Blow is Inflicted in such 
a Manner as to Lay the Bone Bare, which is 
sometimes done by the Surgeon, in this Case You
have not that Guide as you had in the former
Case to goes by, but when the Dura Mater is Injured
You will have the Edges of the Wound all round
the Surface separated, the Bone will Look Dry
and Yellow, when such an Alteration has this 
happens be Attentive to the Symptoms. In all
these Diseas's the greatest Chance is taking it early
by Bleeding frequently, You will have Inflamation
Suppuration Delirium and Spasms, When such
Symptoms happen as Lead You to Judge there
is Mischeiff internally; You must not Wait
but when the Circumscrib'd Tumour wth. its Usual
Puffiness and Detachment happens You shoud then

Perforate the Bone, for if You Wait the Rigors/ the 
usual Attendant on this Disease will Come on, You will
by no Means Give Your Patient a Chance that he would
have had, if You had Perforated the Bone sooner
this is a a Matter of Serious Consideration also to be
Careful that the Disease Exists. If You doe it in
the early State, One Perforation may perhaps doe in 
the middle sometimes two or more are Necessary....

Lecture 9th.
Fracture of the Cranium.
Fractures of the Cranium may be Divid'd into two
Species the first in simple when the Bone remains
even; the Second when there is a Treatment wth. Depression
The Symptoms are Said to be frequent Vomiting a Stupor
and Loss of Blood, from the Nose and Ears, but remember
You are by no means to Rely on those Symptoms
for they may happen Independant of Fracture, and 
when they doe happen they doe not Arise from the 
Solutio Continui of the Bone, they Arise from the 
Concussion of the Brain, or from Extravasation
Seat'd in the internal or external Part of the Cranium
As my Intentions are to Set You Right, I can not
Help repeating what I have already Observ'd, in 
the Preceeding Lectur's without You recollect what 
I have Mentioned. You will be Yourselves at a great
Loss in My Following on's. In the Common Method
of Heaing the Fractured Cranium it is right 
to Perforate the Bone, and there be no Solutio
Continui As other, Purposes are Saved thereby
there are those Causes for Perforation two of which 
are Matters of Necessity; the Head is a Matter of Elation

or Choice, and this is Call'd the Preventitive Kind
of Remedy, the two former from the Consequence of 
Necessity, As when You have Reason to Suppose there 
is a Fluid seat'd in the internall Part of the Skull
it then becomes a Matter of Necessity, the Symptoms
are Caus'd by Violence done to the Vessels or Membranes
and by Fracture, the Performing the Operation
by Way of a Preventitive has Caus'd great Disputes
among Writers, there has been some few Instances
where Fractures have done well without Perforating
but this seldom happens, that was You to Compare
them you would not find an equal Proporation, between
those when it has been Perform'd, and those to
whom it was not, but sure no Man would goe to
Perform an Operation without an Absolute Necessity
The Consequence Arising in the early State from 
Fracture a Extra Inflamation, and in the latter
Suppuration, and if You Compare the Number
of those which Survive when the operation is 
Performed in the former State wth. those who
Perish in the Latter You will find an amazing
Difference, I doe this to this to Show You the 
Absolute Necessity there is in Perforating the Bone
Considering the Number in both Hands, to these 
Cases I shall, add another; In Case of Extravasation
You have Indicating Symptoms and if You

defer it until the Latter, that is when Inflamation and 
Suppuration Come on; I say when this happens You
will find it frequently fail, and the Patient do's not 
Stand that Chance he did; had You made Use of 
the Preventitive Method; And when You doe Perform
the Operation it is not in Consequence of the Bone
being Broken, but from the Alarming Symptoms
wch. happen to the Soft Parts from Injury being
done to them; the next Consideration is the 
Objections our forefathers had, the one Reason
was the Air having Access to the Internal Parts,
besides this their Instrument where exceeding
Clumsy are often times to Injure the Membranes
and this render'd them Fearful of Performing the 
Operation; Its very, Strange the fear of Injuring 
the Dura Mater shoud then Deter them, When
their Writings Mention the Dura Mater was not 
Adherent. Mr Patt Says the Ills Arising from the 
Perforation in every Way Consider'd by no means
equal to the Fracture be it smaller larger.
I shall first Mention 2 or 3 Circumstances where 
the Operation may become necessary. If the Bone
be Broke and there should not be any appearance 

of external Violence, You will Consider it as a Contusion
will Bleed and Purge the Patient, and at the end of a 
certain Time as 4 5 or 2 5 Days. Febrile wth. other Symptoms
which will Reduce you to Examin. If You find any 
Tumefaction You will Open it, You then most 
likely will find underneath the Tumour a Quantity
of Sanies, and a Fracture; No Man a Live could
Hesitate a Moment to Perform the Operation,
You will find the Dura Mater Detach'd and more 
or less Matter Form'd, and You Let it out 
immediately and by that Means You'll Give
Your Patient Relieff. You doe not Perform
the Operation because of the Fracture, If the 
Fracture remains then no Harm can Arise from 
that. If Considering it in another Light it 
happens at the Time of the Accident. There is 
a Lacerated Wound of the Scalp; You will Drop it
after the Manner of any other Wound Inflicted
on any other Part of the Body, And at the 
End of a certain Time, the Wound will Change
its Colour and Appearance, and the Pericranium

for a certain Space round, will be Detached
the Perforation, is Now Necessary to Let it out what
was the Cause of the Disease, there is but now 
one Reason why you should Perforate on the 
Fracture and that is where there is a Fracture wth.
Depression, You then are to Perforate in such a 
Manner as for to [illegible]  You to Raise the
Depressed Portion.----

Lecture 10th.
On the Application of the Trephine.
Perforating the Skull becomes Necessary from the 
Extravasation of Blood, or Lymph. I am Now to 
Describe to You the Manner of Performing this 
Operation by Removing a Portion of the Bone,
to Prevent or Remove the Injury Arising from 
the Blow Receiv'd. An Observation Our
Forefathers made was that on Examining.
The Dura Mater immediately a Streak of Blood
was found on its Surface after a Fracture
that in Consequence of this they had [illegible]
to Enlarging the Fracture imagining the Sanies
Decpt from the Edges of the Fractured Bone and they 
through fear seldom Performed this Operation.
Whoever Varios the Instruments they made
Use of will not Wonder at their Fearfulness
One Error amongst the Rest was their Manner
of Applying their Instruments to which was 
Usualy to one side of the Fracture, His Call'd
the hepan and it is a very bad Constructed

Instrument and the operator Labours under a great 
many Difficulties, and Inconveniences, but its
certainly an Improvement, the Instrument Now the 
of is Call'd a Trephine, and is much better
Constructed than than other. The Skull is Perforated
to Prevent or Remedy any Evil Arising from
Injury done to the inner Parts, from the Blow
Receiv'd by Perforating, Your Intention is to 
Remove such Injury. When You are going
to Perforate the Bone, You are if possible, to fire
Your Instrument in such a Manner as to Include
both Edges of the Fracture, the larger Your Trephine
the better and which I would always Recommend
to Your Use, When You have Perforated a small
Way into the Skull, You are to Remove Your
Instrument from Time to Time, and thus going 
on gradually and wth. Caution, the Operation
is Capable of being Performed wth. Safety.
But one Perforation will not doe, If You 
find a Deluge of Matter, and the Dura Mater
a Considerable Way round Detach'd You will 
be Obliged to make a Second Perforation 

in Order to give an opening to the Matter there 
Secret'd and sometimes a third will also become
Necessary, You had almost better to Let a Part Perish
than to make an Idle and insufficient Attempt; I 
Recommend to You if possible to Remove the 
whole Fracture, it sometimes happens after
some Days after the Operation Your Patient will
have Febrile Symptoms Come on; And other 
Appearances which will Render You able to Judge,
that there is a Lodgement of Matter, You are then
Necessitated to a Fourth Perforation. In a simple
Fracture You have not so good a Guide in the 
beginning as in a Fracture Attend'd wth. a Depression.
In that Case the symptoms are such as Lead You 
to Judge, from the Pressure made on the Organs
of Sensation and Motion, You are then to Perforate
on the side in Order to Elevate such Bone, therefore
the Instrument is applied different in this Fracture
from the simple in Situation in Situation I would
always Remove a great Part of the Depressed
Bone, and not Content Myself wth. merely Elevating 
the Bone. If You doe it is more than two to one 
that Your Patient will Perish, You shoud if those 

is a Hazard of the Bone [illegible] get a proper Assist
to Elevate the Bone, which You Perforate. In the 
simple Fracture You have one Object to Remove (viz)
the Cause but in that wth. Depression You have two
the Cause and the Depressd Bone; there has been
much said about the Dressings and Bandag's 
after the Operation, all Kind of Initiating and 
Depressing Applications should be Avoid'd, I Know 
of none better than soft Dry Lint, You can not 
Apply Your Dressings too Light for this Reason
I would Advise [illegible] other Bandag's than
merely to Retain the Dressings, for this 
Purpose a Common Yarn Night Cap, which is 
Capable of being Dilated and makes an equal
Pressure, the different Bandag's delineated
in Books are very Prejudicial.---- 

Lecture 11th.
On Extravasation, and Concussion of the 
Brain, and Caries of the Cranuim
In the Fourth and Fifth of the Reading Lectur's, I have 
Endeavour'd to Point out the Prognostic's Appearances and 
Method of Treating all Cases Arising from Extravasation
Extravasation of Fluid, And Commotion of the Brain, in 
Two very Distinct and different Causes, they may 
Arise from wth. or wth.out a Fracture; Extravasation
from what Cause sooner it may Arise is different in its 
Appearance, it may either be in a Fluid or in a 
Coagulated Form, or as I have seen it a mere 
Lymph, or Lymph mixed wth. Blood, it is likewise
as differently Situated; sometimes between the 
Skull and Dura Mater, and at other Times between
the Dura and the Pia Mater, and sometimes in the 
Ventricl's, it may either be in smaller or in a 
larger Quantity, upon this Depends in a great 
Measure the sooner or Later Appearances of the 
Disease, and from its different Seat so will You
have greater or less Hazard, when it is situat'd 

the Skull and the Dura Mater, it is not so
hazardous, as when Situat'd between that and 
the Pia Mater, and still greater when its Situat'd
between the Ventricl's, one Unhappy Difficulty
We all Labour under, in Extravasations, they have
different Kinds of Symptoms tho we may always
Judge of Pressure by the Patient Loss of sight
and Voluntary Motion, Yet We cannot be certain
of the Seat of the Extravasation, yet in that Instance
where there is a Depression of the Bone, We have is 
sometime in our Power to Cause an Absorption of 
the Extravasation, I have Seen Cases where the 
Extravasation has happen'd in the Venticl's, and 
the Symptoms Come on Gradatim, Which
Plainly Shews the Lymph is to be Shed gradually
what Kind so ever the Extravasation, either of Blood
Lymph or Coagulum, there are but two Methods
Proposed for their Treatment the one is to Cause
a free Evacuation, and the other by Perforation,
at the Time the Blow being Receiv'd, If You
have a Contus'd or Lacerated Wound, You have then
some Sort of an Authority where to Lay Your
Trephine, When You have not such sort of Apperances
You must Perforate in such a Manner, as Appear 

The most likely to Remove the Blood or Lymph
Your Dressings must likewise Coincide wth. Your
Intentions, all those which Cause Irritation must be  
Avoid'd; It vary often happens after You have Perforated
the Skull You will find the Dura Mater of a Silver
Colour, at others of a quite different appearance; No Blood
or Lymph is to be Seen, on the Surface of the Dura 
Mater, and it is Elevated where the Perforation ever made
made, it is a Doctrine recommend'd by some Writers
to Divide the Dura Mater but unless there is Blood
to be formd, and there shall be appearances, such
as Change of Colour on the Dura Mater, and such 
other Symptoms as Lead You to a Necessity of 
Making such a Division, I by no Means Advise
You to Divide the Membrane, but where You have
these Preceeding Symptoms Attend'd wth. an Elevation
of the Scalp, You will there have Mischeiff underneath,
and you must then Divide it; If at the Time of the 
Accident a Piece of Depressed Bone or any
Foreign Body shoud Lacerate the Dura Mater
ill Effect will then Arise, so likewise from 
Lancet or Bristory, tho I dont regard the Perforation
I seriously Advise the Division of the Dura 
Mater, I was sent for to a Boy a few months ago to 

belonging to Christ Hospital, when I soon found
a Fracture Occasioned by a Part of a Scaffold falling
upon his Head. I trepan'd him and from appearances
Judg'd of Necessity to Divide the Dura Mater, by 
which Means a Quantity of Coagulum was Discharged
and the Boy was Instantly Releiv'd, and Remains
now in Perfect Health. A Concussion of the 
Brain has been spoken of in a general Manner
but it is a distinct Disease, and should only
be Consider'd in a single abstract Manner.
By a Commotion I mean such a shock as has
been Given to the Medullary Part of the Brain,
as happens to both Cases from Persons being
Knock'd Down, they have a Swooning this Arises 
from Commotion and is not the Effect of Pressure
As I have seen several Instances from a fall
a Person shall Receive an External Injury upon
the Head, but having when falling been in such 
a Position as when sitting has Given such
a Shock to the Brain, that has been follow'd by 
such Symptoms as that Death, has often
been the Consequence, the Patient becomes
Irrational, frequent Bleedings wth. Opening
Medicines should be made Use of 

for the Operation, all You can do is to Procure
Evacuations wth. regards to Wounds Inflicted on the 
Meninges they should be treated, in such a Manner
as will best tend to Prevent Inflamation; It remains
now to Tell You the Certain Place for Performing
the Operation, You are Justly Forbid to Perforate the 
Skull on the lower Part of the Os Frontis; On Account
of the Frontal Sinuses's, Another Part in which We
are forbid by Writers is the Posterior Part of the 
Os. Occipitis, the Os Temporum, is another Part to
hear of Dividing the Temporal Muscle, but those 
Writers Consider'd not that it was impossible to 
Perforate the greatest Part of the Parietal Bone,
without the Previous Division of that Muscle and 
its Tendon, Another Cause of Fear was the Division
of the Artery, the Locked Jaw is a Local Disease
and do's not Arise as some Imagine from a Division
of that Muscle, Our Forefathers forbid the 
Perforation on the Sutures, Supposing the 
Hemorrhage would be so great as to Prove 
Dangerous; I by no means Recommend the 
Perforating the Sutures where You can Avoid it.
I doe not Mention it as I would have You
Guilty of Rashness, but to Show You the 

Longitudinal as any other Sinus may be 
Punctured, without that Danger or Ill Consequence
Arising from it, I once Purposely open'd the 
Longitudinal Sinus of a Woman I hapen'd which 
instead of Producing any ill Effect rather Gave
Releiff. A Caries of the Cranium sometimes
happens and is Produc'd from Two Causes, the 
one is from External Violence, and the other is from
the Lues Veneras About ten Years ago an Elderly
Man was Riding in his Coach, was by a sudden
Joilt thrown from his Seat, and Struck his Head
against an Iron which was fasten'd at the top of 
the Coach, he felt at that Instant an Acute Pain 
but it soon Went off. Sometime after I saw him,
and found his Head in an Erisepellatous State
there was a small Wound, and upon Examining 
I found the Bone rough; and to my great
Surprize Reced'd from My Fingers, which 
immediately Gave him immense Pain, I Remov'd the 
Carious Part and then soon became Well. In a Venereal
Cause they likewise become Carious when the Disease
when the Disease in the soft Parts. A Mercurial
Process is Useful, but the Moment it Cease to but

as a Medicine it becomes a Poison. I have been an Eye
Witness to this in Numberless Cases, when the hard
Parts are Attach'd You must have a suppuration, and this 
is only to be Effect'd by a Nourishing Diet, and where 
it may be proper to make use of the Hard Recruit.--

Lecture 12th.
On the Fistula Lacrymalis.
The Subject of this Lecture is Commonly, tho
improperly Call'd the Fistula Lacrymalis, there
is no Disease wth. which the Human Body is Affect'd
has Caused a more Variety of different Opinions
amongst Writers than this has done; the Ancients
where very Erroneous in their Method of treatment,
their first great Cause of Error is their having 
mistaken one Part for another, they likewise
being Unacquainted wth. the Part where the 
Lacrymal Fluid was Secret'd; you will find both 
amongst Ancient and Modern Writers a Variety
of Opinions about the Seat or Lodgement
of this Fluid, their Descriptions are Inaccurate
they where of an Opinion that the Caruncle
became and In Cyst'd Tumour, but they all
Agree in this Point that of an Induration
and Caries of the Bone according to their 
different Opinions, so likewise they differ in their   

Manner of Treatment, they who Imagin'd the Diffusion
more from Inflamation and endeavor'd to suppurate
the Carunculi others by making an Incision to the 
Carunculi in Order to Eradicate it, and others
made Use of Ecsharotic Applications, Whoever
Treats it in this Manner can never succeed in his 
Intention, by Irritation it is Certain You encrease
the Disease, Vision could not be Perform'd
wth. that Facility it now is unless the Surface of 
the Coats where Kept Continually Moist, and free
from Dust or from any Irritating Body, the 
Lacrymal Glands Serve for keeping the Tunicæ
Cornea Moist, and bright and to Remove
any Dust from this Coat, when by Accident
they are Stimulated either by the Passions
of the Mind, or by any Extraneous Bodies, the 
Lacrymal Fluid becomes so much increased, as 
to Run down the Cheeks, it is then Call'd the 
Tears, when the Disease Exists, it is sometimes
so Avid as to Occasion Excoriation, of the Skin
the Quantity of Fluid is not Known, the 
Lacrymal Sac is Situat'd in the Ductus Nasalis

which Opens into the Nose, behind the Os Spongiosa
Inferiora, the inner surface of this Duct is Besmeared
wth a Fluid to Prevent any Irritation. The Fluid
Devis'd from the Lacrymal Gland is Facilitated
by the Motion of its Lids, is Receiv'd by the 
two Puncta Lacrymalis and then Convey'd into
the Sac, those who Labour under this Disease
from what Cause so ever it may Arise have this 
Sac Obstruct'd, the Consequence of this is the 
Tears run Down the Cheeks, this Disease as 
its Origin from a Variety of Causes. In the 
beginning from improper Treatment sometimes
after the small, Rose, or from the Mucus Membrane
which the Lacrymal Sac being Obstruct'd.
The Moderns Say that this Disease in its
first State Arises from a Lodgement of the 
Lacrymal Fluid, all Obstructions of the Fluids
when Lodged become very Hurtful. Its Colour
Depends on the longer or shorter Existance of the 
Disease, so do's the Colour Change. It has been 
Improperly Calld Pus, as I Mentioned before,
It Arises from a Variety of Circumsances and 
is Attend'd wth. such as Form Obstruction in the 

Nasal Duct, If by ill Treatment the Bones should
become Carious, as sometimes happens from the 
Pore Polypus or Cancer, so according to the Disease
and other Circumstances, You are in a great Measure
to be Guid'd, in the Manner of Treatment, or other Means
You are Oblig'd to make an Opening for the Discharge
of the Fluids, some of the French make Use of a Syringe
to Inject the Sac. If it will Pass from the Lacrymal
Sac into the Nose it may doe, but whoever will
View the Syringe and Probe they make Use of will
See the Impractability of the Operation, Compress and 
Bandage have sometimes been made Use of wth. Success, but 
then this Pressure must be in such a Manner upon the 
Bay as will Remove the Obstruction, and avoid
giving Irritation, I have tryed that Invention of Mr Sharp's
but is Proves Ineffectual, You will find in the 
memoirs of the Royal Academy at Paris, a Variety
of Methods for to Remove the Disease, there Two 
Methods now Observ'd, the one I think very Rational
the other rational Method I recommend to You 
is this, by making an Incision into the Duct and Passing
the Knife in such a Manner as not to Injure the 
other Parts, having made Your Incision, You are then 

to Apply Lint, in such a Manner as to Preserve
Your Opening, and then gradually Dilate it by a 
Piece of Spunge or Bougie, or a Piece of Lead,
which must be Introduc'd to Pass the Nasal Duct
and thereby gradually Dilating the Opening, a Cure
will be Effect'd; the Tent must remain in Three
or Four Months least the Disease should be Renewed
the Scar by these Means will become very simple
this Disease is often very difficult to Cure, but its often
Owing to their going on Dilating and Causing
Inflamation, which ought always to be particularly
Avoid'd, all Kinds of Bandages or Pressing Bodi's 
are Prejudicial; I am now to Inform You of the 
best Method of making a New Channel, when either
by this Treatment or any other Cause it is so Obstruct'd
and not to be Remov'd. The Ancients made Use 
of the Caustic and Terebra, when we doe it We only
Mean to Perforate into the Nose, the most frequent
Method for this Purpose till Lately was the Cautery;
Mr Chapaldon Stands first for the Inventing and 
making Use of this for the Removal of this Diseae;
I have Seen many Disagreable Effects Arising from it 

for in Spite of all Your Efforts to the Contrary You will
Destroy the Neighbouring Parts, which most Certainly
You ought to Avoid doing; For the Purpose of 
making this Opening, there is a much better
Contrived Instrument, the Curv'd Trocar, when You 
have made Your Perforation, which You will Know
by Blood Passing through the Nose, then Apply
Your Tent of Lint, and then some Drawn Lead to 
Maintain the Opening taking Care to Avoid
giving Cause to Inflamation, and lastly not 
to Remove Your Tent till the Time above Mentioned. 

Lecture 13th.
On the Cataract.
The Eye Consists of Three Coats, tho there are 
some who have made five. It has likewise the 
Humours. The Tunica Sclerotica, the Tunica Cornea
which is Transparent, and the Tunica Retina, wn.
The Tunica Ubia and Iris; the Humours are the 
Aqueous which is the Anterior, the Chrystalline
and Vitreous, which are situated Posteriorly,
the Diseas's of which I am now to Speak have been
much Misrepresented, by Writers, it has been Supposed
as Consisting of a Variety of Circumstances, it has 
however one Plain Disease, It is an Opacity
of the Chrystalline Lens by Vision is Variously
Imped'd or wholy, Destroy'd, it Varies in its 
Appeance and Colour (Viz) of the Pearl Blue
Brown &c, the general Doctrine in regard to this 
has been that at first when the Disease has made 
a small Progress, it was then Immature; but as 
the Disease increased it then became Mature 

and fit for the Operation. That this Doctrine is not 
always true is very Certain, I have several Times seen where 
from a Blow being Receiv'd, the Chrystalline Lens becomes
immediately Opake; Again I have seen where the 
Cataract her remain'd in a Fluid State all the Time
The Disease has Exist'd, therefore the Shortness of 
the Time making it Mature or Immature, is Uncertain
I have seen the Chrystalline of a Living Animal as 
Capable of Resisting as in the Dead Body, the 
Dissolving of the Chrystalline Humour is Proceeded
by a Pain of the Head, in those that appear
While and Indurate is sometimes the Effect of 
Age, there are some Circumstances which Determine
the Event of the Cure. If the Patient and 
Opake Chrystalline can Perceive the Light there
is scare Hopes of Success, but if the Patient
cannot Discern the Light there is a little more.
Besides the Dissolved and Indurated Cataract
there is Another which has been Term'd the sheting 
Cataract, another Circumstances which shoud be 
Consider'd is the Mobility of the Papillae, which 
if immovable is very Favourable, but if not the 
Operation should not be Attempted, If You Look 
into Books You will find a Variety of different 

Methods for Performing the Operation, the Disease
in its Cure is simply, there are two Methods of 
Operating now in Use, one by Depression of the 
Chrystalline Lens which is the Oldest Method, the 
other is by 3 Extraction; the Latter took its Rise
from Accident as many other Improvements
in Surgery have done, to Extract the Chrystalline
Lens You make a Transverse Incision on the 
Cornea a taking Care not to Injure the Eyes when 
its Coats Unite, by this Means You will Preserve
the other Humours from falling out, in Order to 
Depress the Chrystalline Lens, You Pass
Your Needle in the same Manner, but Pass Your
needle into the Posterior Chamber of the 
Aqueous Humour, You are then to Turn Your
needle breaking Down the Cataract, and when the 
Papilla becomes Clear, You are to Depress it,
sometimes it will rise again on the Patients
Stooping Down, and again Sink Down on the 
Patient being Erect, sometimes it happens that 
the Division of the Cornea will not Unite, and 
a Quantity of Humour will fall out, the Light
still remains, the best Method I think is that 

by Depression, as You have not so many
Inconveniences Attending it as by that of Extraction
after the Operation a Plaister of Soap Cerate shoud be 
Applied and the Antiphlogistic Regimen follow'd
frequent Bleedings to Prevent Inflamation, and 
if necessary opiates should be Administer'd. 

Lecture 14th.
On the Polypus and Hair Lip
The Polypus Narium is a Disease concerning which both
Ancient and Modern Writers have given very 
different Accounts, wth. regard to the Manner of 
Treatment, but that it was one distinct Disease,
It has however very different Appearances, and 
is Attach'd to different Places, sometimes from 
the Septum Narium, or from the Pituitary
Membrane, sometimes from the Os Spongiesa
or Hanging from a stalk. It is sometimes
Indolent and at other Times Not, and the Bone
to which it is attach'd will sometimes become
Carious, whoever fills himself up wth. Hopes, that
a Polypus will be easily Cured, will find himself
much Deceiv'd. the Cheiff of the Ancient Writers
seem to have been at great Pains, to find out 
some Remedy to stop the Hemorrhage which
they Imagin'd happen'd after every Polypus
was Extracted, and this seems their Grand Object 

in View, but Venture to Lay that those Kind
of Polypus wch. admit of Extraction and are Curable, that 
from these no Hemorrhage will ever Ensue, wch. will Require
Assistance to Stop, I never Saw but one Kind of Polypus
which would Admit of Extraction, or being Cured, More
Kinds of Polypi that are not moveable and are
not differently Affect'd by different Kinds of Weather
and that Put on a Cancerous Appearance, had much
better be Let alone for by Attempting this You
will not Succeed, that Kind of a Polypus, that may 
Admit of a Cure is that which is Movable in Respiration
When the Patient has no Cold it Appears as if 
filld wth. Colour'd, Lymph, and that on taking
Cold becomes troublesome, and in rainy Weather
becomes Enlongated and enlarg'd. If Frosty becomes
less and Contract'd, and on Pressing it a little
Fluid Drops from it, those Polypi which doe
not Answer this Description, will not Admit of 
the Operation; Escharotics which have been made
Use of in this Disease Serve only in My Opinion
to encrease it, some have made Use of Ligatures
but it is difficult to Pass them high enough to the 
Rest, without that You doe not remove the 
Disease; the Polypus is generally Attached to 

the Os Spongiosa; the Method of Extracting
the Polypus is to Pass it up to as near the Root
as possible, a Pair of Forceps wth. Holes in and 
Fall down in a Reight Direction, and not by
Forks, and Hoisting the Forceps and You will
Detach it, It sometimes happens a small Portion
of Bone will Come away wth. it, but to this 
You will Pay little Regard. Those Writers
who Say a Polypus will Grow again, from 
the same Place where the other was Detach'd
have Wrong Ideas. Those which are so much
enlarged as for to Hang Down, and appear
in Sight, either without the Nostril or behind
the Velum Pendulum Palati, are all distinct
Polypi, and that after the Removal, of one error
You shall have another in a short Space.
It has it Attachment at another Part, and 
will Come Down in Consequence of the other 
being Remov'd. 

The Hair Lips
The Hair Lip is of Four Kinds, two of which are Confin'd
to the Lip only, the third is attend'd wh. a Division of the 
Manilla Superior. The Fourth is Attend'd wth. an Horizontal
Protrusion of the Denticular Ridge of the same 
Bone in the first which is only a Simple Division
of the Lip You are to make an Incision on each 
Side so as to Remove the Callous Edges, and Procure
a Speedy Reunion Some have been of an Opinion
that when this Discovers itself at Birth it is much
better to Put off the Operation for a Time, for these 
Reasons Children are apt to Cry, and are apt to 
Endeavour to Remove their Dressings, but these
are very Triffling Objections, for My own Part I never
Object to Performing the Operation, but rather 
prefer it at an early Age; After having Pared
of the the Edges, You are to Introduce Your
Pins and Suture which is the best Method, tho
I have seen the Common Interrupted Suture wth.
Sticking Plaisters doe very well In the Second
You will have two Separate Divisions Opposite
Incision You can not Heal both at the same Time, but
having Perform'd one and suffer'd it to Heal to and [illegible]
the other Under the Division of the Lip You will

sometimes have an Horizontal Protrusion of 
the Maxilla Superior which Comes under the 
Fourth Kind, this must first be Remov'd before You
Attempt the Cure in this Case the Dentes
Incisioi must be Soft, being Oblig'd to Remove
a Portion of the Alveoti sometimes there is a 
Division through the Maxilla; And in this Case
You will Expect to the Benefit; the Impediment
in Speech the Difficulty in Drinking must 
all be Submitted too all You can doe is to 
Unite the Soft Parts, and render the Deformity
less Obvious; The Pins now made Use of are now 
much Improv'd. There Points Screw off which 
Prevents many Inconveniences both to the 
Patient and to the Nurse, which before they 
where greatly liable to.....

Lecture 15th.
On Diseas's of the Trunk
and Thorax.
I shall Divid them into Two Heads, first those that 
happen within the Cavity; and 2d. those that happen
without the Cavity, there within are the Vomica 
Empyema and Hydrops Pestoris, those without are
Wounds and Fractures of the Ribs; Empyema
Cancerous and schirrous Breasts, Wounds on
the external Parts are Triffling, but You must Pay
Attention to Prevent, Inflamation, which is 
Liable to happen, from the Lungs in Respiration
Those Wounds which Penetrate the Cavity of 
the Thorax are Matter of Consequence, they should
be Dressed as Quick as possible, to Prevent the 
external Air, which besides Compressing the 
Lungs, and necessarily Preventing a free
Respiration, will likewise Impede the Circulation
of the Blood, and Stagnating it in the 

Right Auricle. Those Consequences will Arise from 
Wounds Perforating the Cavity of the thorax independent
of any Injury Communicated to the Lungs, and 
which the external Wound Appears largeness
sometimes Unhurt. tho in Perpetual Motion
free Respiration and the Impulse of Blood.
When any Injury was Communicated to the 
Lungs, the Ancients Pronounc'd it Fatal. But they 
are not always so. It Depends upon what Part
they are Wounded; At the lower Part they are 
not so Dangerous, the Ramification of the 
Artery are not so great as they are high up
But the Danger in a great Measure Depends
on the Size of the Wound it may be Raise'd high
up Yet the Patient may Recover. from any 
of the above Mentioned Causes, the Lungs may 
be either Compress'd, or Inflat'd so as to Prove Fatal
by the Blood, Stagnating in the Right Auricle
of the Heart, A Case that I saw a few Years
ago will Prove the none Fatality of a Wound of 

the Lungs; A Boy a Waiter at a Tavern running 
up Stairs hastily wth. some Knives in his Hand
Slip'd Down, the Knives also fell and one of them perpendicular
wth. the Handle of it in a Hole, which the Boy
fell upon, I was Sent for and found a large Wound 
on the Right Side, and from which when a 
Candle was Held to the Part, was immediately
extinguished by the Air returning out.
There was some Hemorrhage, but that Ceas'd to Flow 
of itself it was Drop'd Lightly and Speedily
and the Boy did well, not Attend'd wth. any 
bad Symptoms; there Accidentaly some of the 
Vericulae Airiae was Wound'd on the Surface of the 
Lungs, when the Wound was Exposed he was in 
great Danger then of suffocation; therefore Nature
Led him to Cover it wth. his Hands, which he 
was Obliged to especially in the Night, when by
Accident the Dressings where Unavoidably
Removed, Fractures of the Ribs are Painful
and Troublesome, the Method of Treating them 
is to Kind a Napkin round the Body, Oily 

Medicines, Opiates and the Antiphlogistic Regimen
shou'd be made Use of to Prevent Inflamation, but it
sometimes happens that of spicula of the Fracturd
Ribs will Press through the Pleura and Wound
the Lungs; the air then Rushing into the 
Cavity fills the Tela Cellolosa, when every Part
of the Body which has any Cellular Membrane
will be Distended also and Cause the Disease
Call'd Empyema, the Lungs will Perform
their Office wth. great difficulty and the 
Patient generally Dies of suffocation, and 
non Circulation; Puntures and free Incisions
are Said for to Cure the Labor, I prefer as it 
will give a more and greater Passage to the Air
You are then to make Use of Friction upon the 
Emphysematous Tumours, wth. Your Fingers
which are always to be Oiled to Prevent giving
Pain and Inflamation, Yet Notwithstanding all
this it is mostly Fatal. The Breasts of Women as
liable to many Diseas's; Abscesses are what 

I shall now speak of; they are very frequently
Caus'd by the suppression or Driving Back of the Milk
which Custom Rewards the Intention of Nature,
which is done to Avoid Trouble or Suckling of the 
the Child, or to Avoid Sporting the Shape of the 
Regular Form of the Breast. Woman should be 
Persuaded to Suckle their own Children, as the 
Mothers Milk Purges off the Meconium, and is 
much more Nourishing than that of Another Woman.
As that peculiar Quality which is in the first
and nearest Milk, is here Wanting in the Strangers
Breast; Render by this they will Prevent the Fever
very frequently occasioned by the Stoppage of the 
Milk, and likewise the Causes of Abscess and 
Indurations; these Kinds of Abscess Incident to 
Women, from the above Mentioned Cause have 
been generally ill heated. The Common Method
which hollow'd in the beginnig was to apply
Adhesive Plaisters over the Breast, and where 
a fluctuation was Perceived, there they Apply'd
Caustics, which Methods by Prudent Men 
are never Practised, some make Use of Means to 

Discuss or to make Absorption and a Suppuration
as we have it in our Power to Assist by either of these
Methods to forward Suppuration, You are to 
Attempt by gentle Evacuant, and Emollient
Poultices Continued till it Bursts, as it then
generally makes a more Depending Opening.
Caustics should never be Applied. If it should not 
Burst of itself, a Puncture will become Necessary
which should be made large enough to give free
Passage for the Matter, As by this Means You 
will be Prevented from making Another, Your
Business is to keep the Divid'd Lips of the 
Wound asunder, by this Means You will give
free Passage to the Matter, which is of the 
Utmost Consequence to Your Patient and to Your own
Character some have Imagined that the Matter
has Pointed in such a Manner, as You will not 
be Able to make a free Discharge, from the 
Nipples being in the Way, but they have been
Mistaken, for You may always Avoid
Wounding the Nipple.---- 

Lecture 16th.
On the Schirrous Breast.
Our Forefathers Gave the Name of Shirrous to all Tumours
that would not Admit of Disputation; The Moderns
Term those Schirrous which will not Admit of 
Suppuration and Bears an Affinity to a Cancer
sometimes only one Gland becomes Indurated at others
more and in some the whole Breast, It Appears
sometimes Indolent and not Painful to the Touch
in others it will not Bear the Touch without Giving
Pain. Whenev'r the Nipple is Retracted the 
Schirrous turns Cancerous, and is generally Fatal;
there are two Methods of Cure, the one by Destroying
it by Caustic, the other by Extirpating wth. the 
Knife; The Idea and Dread of Pain given by 
the Knife, has Induc'd many who Labour under
this Disease, to suffer Ignorant People Unacquainted
wth. the True principal of Surgery, to try those 
Pernicious Secrets which they too open Impose
on the Credulous People as Efficacious, they  

Attempted the Removal first be applying Plaisters
for that Purpose, when these fail'd which they 
always will doe, they Apply'd Caustic which 
are very Painful and Uncertain. Tho there is no 
Appearance of a suppuration, Yet the Diseas'd
Part will not be Clear'd from the Sound, the
Pain is greater than that of the Knife, and of 
longer standing. If You apply Your Caustic
too strong You may Injure the sound Parts,
If too Weak it will not Remove the Diseas'd Parts
and it will also by its Irritation encrease it 
and make it much Worse.
The Composition this Caustic generally Consists
of is Meadow Crowhoot Dog fennel Sulph
Vioum and Arsenick, made into a Paste wth.
the Yolk of an Egg, this is in their general Use
and Come from Stevens Hospital in Dublin,
this is their Boasted Secret, and which many
People are tortur'd wth. the Knife is the best 
Remedy if the Operator Knows how to Use
it, and is Acquainted wth. the Seat of the 

Disease, and Anatomy of the Parts, always
Remembering to have as much of the Sound Skin as
Possible. If the Schirrous Gland Lies deep so that there 
shall be some Cellular Membrane and Adipose
Situated between that and the Skin, you must 
make a Longitudinal Incision which will 
sufficiently enable You to Dissect out the Glands
at the same Time Preserve the Skin. The Cancer of the 
Breast has a Variety of Appearances and Appears
under a Variety of Forms, it is sometimes Painful
sometimes Movable, and immoveable, When 
Movable in a favourable Circumstance, it Indicates
there is a Cellular Membrane between it, and the 
Muscles of the Latter it is Unfavourable, and 
should not be Attempted, as the Cellular Membrane
is Indurated, and is Attach'd Firmly to the 
Ribs, a small Degree of Mobility should not 
Deter You from Performing the Operation,
Circumscription is another Circumstance which 
is when the Breast shall be Perfectly Movable
but the Parts of a few Inches round shall be  

Adhering, this also shou'd not be Removed as 
You most likely encrease the Disease
sometimes You will have the Milliary Glands
as large as Grains upon the Breast, this also
shou'd not be Removed, as you most likely
encrease the Disease, and bring on Additional
Pain. Whether the Breast be Ulcerated or not
it should be no Impediment against Your
Exterpating it; If the Pain be very Severe You
should Suspend the Removal of it, so also of 
the Glands in the Axilla or Neck be enlarged or 
Indurated, it is a certain Proof the Disease
Exists in the Habit. I have Mentioned a Variety
of Circumstances which are Prohibitions for 
Performing the Operation; the Prospect of Success
in Those Cancers which Arise from Internal
Injury are greater than those which does not 
as the Latter Indicates a Disease of the Habit.
A Cancer in the Scrotum Attend'd wth. Darting Pain
in the Back is Dissuasive, tho not always a 
Prohibition it sometimes being Local, 

A particular Circumstance to be Observ'd, is the Obstruction
of the Menstrual Discharge, which You should be Careful
to Perform before the Operation; On the other Hand if the 
Menses have Ceas'd to flow, their Bodies will undergoe
so many Changes, that You will have many Difficulties
to Encounter. The Present Method of Operating is this;
the most Painful Part of this Operation as in all 
others is in Dividing the Skin, which tho I am an 
Enemy to Calarity, shoud be done as Quick as 
Possible, You are to make two Semicircular Incisions
round the Breast into the Membrane Adiposa
Dividing Downwards to Dissect it from the Pectoral
Muscle, Leaving it as Bare as Possible, and 
taking Care to Remove all the Diseas'd Parts,
You will have but few Vessels to take up as the 
greatest will Retract themselv's; You shoud then 
Dress it Lightly wth. Dry Lint, and not to Remove
Your Dressings for at least four or Five Days being
Elaps'd, in short untill Suppuration is fully and 
Establish'd, as they will fall off themselv's, You will
then have a Clean Sore. But I am Sorry to Say 

after all Your Care, You will sometimes not 
Succeed, The Sore will have Promising Appearances
and shall Heal Kindly until about the Size 
of a Shilling when its Appearances will Alter,
it will become Glassy and will Spread, it will
Degenerate into a Phagedenic Ulcer and the Patient
will become Hectic and Die.---- 

Lecture 17th.
On the Hydrops Pectoris
The Disease may Arise from Two Causes, when the 
Body is Affected wth. a general Anasarca, and when it 
is Confind solely to the Cavity of the Thorax, the 
Hydrops thoracis is the same Kind of a Disease as 
the Ascites in the Abdomen, they both Arise from 
one and the same Cause, there is a Fluid Constantly
Transuded from the Pleura, which is Constantly
Absorbed; Whenever this Secretion becomes greater
than the Absorption, An Accumulation of the 
Fluid must certainly be the Consequence of it 
and which Causes the Disease; The Symptoms
of this Disease Laid Down by Writers are very 
Erroneous; the Disease may Exist and the 
Patient during Life may Suffer very little, and 
the Cause will not be known till an Opening after
Death. The Symptoms which Indicate the 
Disease are very great Depression and difficulty
in Respiration, especialy upon any encrease
of Exercise by the Lungs being Compress'd the 

Circulation will be Imped'd in some Measure
and the Blood is accumulated in the Right 
Auricle, in an Erect Position the Patient do's not 
Suffer so much, as when he Attempts to Raise
himself or Lay Down hastily, and again he 
becomes Easy by being Kept Quiet, these Observations
will Lead us to Distinguish it from other Diseas's 
when the Lungs are Diseas'd it may be Known 
by the Expectoration, which by this Means generally
Leaves the Patient; the Hydrops Pectoris is external 
to the Lungs, therefore Expectorants will not 
Releive, from the Extravasation of this Fluid,
which should Circulate through the Body;
The Secretion of Urine, becomes less in Quantity
but this is not Specifically in the Hydrops
Pectoris. Another Symptom is the Palpitation
of the Heart, from the irregular Motion of the 
Muscles, and is very Different from that 
Palpitation Arising from ye Spasms. The 
Intermission of the Pulse in this Disease is no 
Uncommon thing, nor is it Specifically Attendant
on it. It has been Apart'd by Writers that You may

Know the Disease, by the fulness of the Chest or on 
one Side, but I never was Able by any such
Appearance to Ascertain the Existence of any such
Disease; where there are certain Indication of this 
Disease, You should not neglect to Perform the 
Operation; a Variety of Methods have been Propos'd 
in Order to Perform this, such as the Introducing
the Trocar in the same Manner, as is done in the 
Ascites in the Abdomen. The Method Recommend
to Your Practise is to make an Incision about 
an Inch and a Half long through the Integuments
between the Sixth and Seventh Ribs Counting
upwards near their Angles doing it very Carefully
to Avoid Wounding the Intercostal Artery; You must
Direct Your Knife, near the Inferior Edge of the 
Superior Rib, You are not to Use the least Pressure
upon the Knife, but Use it wth. the same Caution
as when Performing the Operation for the
Prubonarale, You may then safely Divide the Pleura
the Vomica of the Lungs, this Disease is a Collection
of Matter in the internall Surface of the Lungs
Arising from Inflamation; The Cure of this Disease

is sometimes Effect'd, by the Matter being 
thrown up by the Trachea, tho sometimes it must 
Prove Fatal, by the Quantitey of Matter being so 
great as to Cause Suffocation; In a Collection
of Matter upon the external Surface of the Lungs
or in the Cavity of the Thorax, which some Writers
have Mention may be Known by Ocular Demonstration
have also Mentioned the same Method of Cure as in 
the Hydrops Pectoris.----

Lecture 18th.
On Vomica and Empyema
In all Internall Dises's of the Lungs amongst wch. the 
Vomica is Mentioned, Expectoration always is a 
Salutary Sign, when there is an Accumulation
of Fluid in the thorax, the Disease is Term'd Hydrops
Pectoris, and when the Lungs are Diseas'd Previous
to this Accumulation of Fluid the Symptoms
are different, to what they are when there is no 
Disease in the Lungs, they likewise differ when 
there is Adhesions these Circumstances You
shou'd Carefully Consider; There is another Disease
of the thorax, which generally is not Form'd
until after Death, We never Know when the 
Patient is Living. The Hydrops Pericard the 
Cause of this is the same as sometimes happens
between the Tunica Vaginalis and Body of the 
Testicle, and of the Disease already Mentioned
the Hydrops Pectoris, from too small a Quantity
of this Fluid Secret'd Adhesions take Place, the 
tumor I believe to be a Cause of Sudden Death, and 

in those who have a very Irregular Motion
of the Heart, the Lungs are Liable to many Diseas's
Inflamation Suppuration and Induration and 
frequently Subject to Adhesions, by Previous
Inflamation; the Lungs sometimes become
Suppurat'd; when the Matter is freely Expectorated
it is a Salutory Sign, in regard to that 
Matter which has made its Way through the 
Surface of the Lungs, so as to become Floating
in the thorax, Expectoration can be of no Service
and the only Way to Cure will be by making
an Opening to Discharge the Matter, after
the Method above Prepar'd, but there are no 
certain Symptoms which Indicate this Disease
Occasion'd by a Previous Adhesion of the 
Lungs to the Pleura, the general symptoms
of this Disease is Fever hard Pulse a Dry Cough
Parch'd Skin difficulty of the Breathing wth.
an Incapability of Lying on the Side not Diseas'd
without great Pain. By Means of Adhesion
a Fever Produc'd by so Necessary an Organ 

As the Lungs beine Prevent'd from Performing
an Office, so Necessary to Vitality. In Adhesions
of the Lungs, the Patient find Complains of a 
fixed Pain, so small that he can Cover it with 
his thumb and the Pain is encreased on the 
Patients taken in the Air. Adhesions is follow'd
by Irritation and Inflamation which
which is the Consequence of Suppuration, at this 
Time the external Parts become Load'd, and full and 
this fulness is Circumscrib'd which is the Seat
of the Matter. If the Lungs are Adherent partly
from the Inflamation and Pain; the Patient 
Avoids taking in Air freely; as the Disease encreases
the Matter will make its Way between the Ribs;
the Tumour will Appear somewhat Circumscrib'd
in its Figure it is hard in the Middle and Painful
farther from the Centre it is of the Œdematous
Kind, Joind wth. an Erysepellatous Appearance
as it Proceed. You will Perceive evidently
a Fluctuation, and being Satisfied there is 

Fluid Examine it no more, by this Means You will
Avoid giving Your Patient any Unnecessary Pain
and what is of still greater Consequences and 
happens from Pressure You will have the Tumour
Disappear, and the Matter will be Loose in the
thorax, and will be Attend'd wth. Fatal Consequences.
Your Business is always to forward Suppuration
by keeping the Skin Relax'd wth. Poultices.
There are some who Attempt to forward Suppuration
by Adhesive Plaisters, which only tend to Inflam.
and Irritate the Parts, And in My Opinion ought
to be Let alone, but I know of no Application to 
Assist Suppuration. Nature alone if Left to 
herself is generally sufficient where there is no 
Elevation of Parts, Evacuation wth. the 
Antiphlogistic Regimen becomes Necessary,
But when You have such Symptoms and 
Appearances as shew that Nature is Dispos'd
to Suppurate, You are then to Abstain from 

general Evacuations; when the Fluctuation of 
Matter is felt and the Skin Puts on an Inflammatory
Appearance, You are then wth. Your Lancett to make 
a Puncture, having done this You are to Introduce a 
Probe Pointed Bistory, and make an Opening sufficient
to Discharge the Matter, and then Carefully Attend
to the Habit of the Patient; You are to Apply some 
Lint to the Lips of the Wound to keep them from 
reuniting till the Matter is entirely Discharg'd,
this is sometimes so great as the Patient will
Sink under it. sometimes the Discharge will be 
Continued so long that it will be in Appearance like 
Sanies, it will be Requisite, You shoud apply
a Canula or Use some Means to Reserve the 
Wound Open, taking Care to Avoid all Applications
which Tend to Irritate and Inflame and Nature
will then Compleat her End.----- 







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B. Book-plate of the Bookseller inside cover.
POTT. L.W.
Lectures on Surgery.
1[8]773-4.

Mr. Potts Surgical Lectures A.D. 73. and 74.

Mr. Potts Lectur/s
on Surgery.
The Introduction
Gentlemen 
My Intention in the following Course of Lectur's
is to treat on the Useful and Important Science
Surgery; and shall not Concern myself in Giving You
a Minute Anatomical Knowledge, or Description
of the Bark; but merely so much as will be hurt
Necessary for our own Purposes, This where I to doe
would be Altering the Plan of My Lectur's; and 
therefore must Defer You to Your Anatomical
Teachers and Books. My Intention is merely to give
you the Practical Parts of Surgery, and which
I shall Endeavour to Say before you, in the most Clear
and Precise Manner that I am Able; some have
Disput'd it being a Science/ others an Art; but it most 
certainly Justly Claims the former. It is needless
to Urge any Encomiums upon on its rise As it is so 
Clear and evident to all Mankind; It was Instruct'd in 
the earliest Times, and different Methods was Pursued
to become the Surgeon; come merely by Perusal

of Books, and Attaind only theory, and there
became by far the Ablest Surgeons in the Closet,
and were apt in Conversation y but in the Practice x
Part where very greatly Deficient, and frequently
at a Loss. And on the other Hand those Introdu'd
by Practise, only wth. the Use of Reasoning or Books,
Labour under an equal Disadvantage, in being
Able to Perform an operation, Dexterously without
perhaps Knowing why it should be done or when it 
is necessary. Different Writers have followed different
Plans, all of which are equaly Defective, and in 
this Particular, they have Confind themselves
in Describing the Modes of Operations merely
wth only wing? You a Clear Account of the Disease,
which requires the operation; they have Given you
the operating Part without Mentioning any Disease
or Prohibitions to any Operation which [Da???]
many Principal Writers [cross out] Labour under; it may
perhaps be Expect'd of Me as is Usualy the Case in
Introductory Lectur's of this Kind, to Give You
an Abstract History of Surgery, which I [cross out] had a 
Power or Capacity to does would Ingross too much of 
that time which I think can be better Employ'd in Parts 

more Beneficialy and Instructive to You; or should 
I do it, it would be only giving You a Series of names
and States. However any one who has Curiosity in him
to Desire to Know this will find the History fully
mention'd in Galens History of Surgery, Clarkes
Surgery; or by Dr friends; the Majority of Writers
have fined a Numerous han of Bandages, and 
Instruments. The first is almost Unnecessary and in
general Prejudicial, nor is is Worth my while to 
Describe them, or Yours to Hear them; the Instruments
are also tedious and Unnecessary, they are very numerous
and an operation was never Perform'd without a great
many of them being Us'd; the Surgeon was never
Imagin'd, unless he produced, or was posses'd and
[illegible] a great number of Instruments; on the 
Contrary I think they cannot be too simple, and
simplicity wth. Respect to Bandages, as well as 
there is always to be Commend'd. There few Bandages
and Instruments which are Useful cannot be too 
Simple, I shall at a proper time Place [crossed out] Describe
them to You; Whoever has the Curiosity to become
Acquaint'd wth. them will find them fully Describ'd
by Scaltehia, and likewise that general Compiler 

of Surgery Neistery this will Instruct You in the 
Choice of Instruments, they are well Described and 
You will find also their Uses. The Methods the 
Teachers of Surgery have follow'd in this. Van
Norn as Divid'd into the ten following Parts, or
Smthutic under which are Dang'd all fractures
Wounds Ulcers and Bruises. The Diabetic; as the
Operation for the hepan, the Eartic or the 
Extraction of Stones, or any rousing Bodies.
The Chartic, as the Extracting of Polypus Excursions,
the Prosthetic, as the Putting in of artificial teeth,
Ey's and Woodan 1 Leg's and Dicorhetic as the 
Management of in Curvat'd Spines. Limbs and 
Clubb feet; and this Plan is regular and very
Superficial, but not at all to be Copied in a Course
of Chirurgical Lectur's. It is Confin'd to the 
Operative Part moraly, a Part very Necessary
to be known, but it Heads not to the Knowledge 
of Diseas's. A Young Man by Studying this method
woud become an Operator, without Knowing why to 
Perform the Operation. He may perhaps doe it when
not necessary Dexterously. First become Clearly
Acquaint'd wth the Nature of the Disease, than where 

the Symptoms shall In. Indicate the operation
and lastly Perform it in the best safest and easiest
Manner as Possible. In Order to render You Capable
to accomplish, thinks may Intention in the following
Course of Lectur's, and which I shall Endeavour to Lay
before You in the most Simple Manner. My Plan
is to make My five or six first Lectur's general,
and to Speak of those Diseas's which are Confin'd
to Particular Parts but are liable to happen in all
Parts of the Body, and having finish'd those begin
wth. the Scalp; and so End regularly wth. the 
Extremities. The Art of Surgery cannot have
too much Said in it Praise, it Unto quite, and 
it Utility, and when properly and Honestly
Practic'd cannot be Deserving of too much Praise.
The Utility of Surgery is well Known to every Rational
Man, Whoever Deflects on the Diseas's liable to be Inflict'd
wth on him, and the Body will immediately on this 
Proposition; Was not the Stone extracted out of the
Irritat'd Bladder what must not evidently have been
the Consequence; On the Contrary the Fracture of a Bone
by proper Position and Assistance of Bandage care,
and Reduction of it may be Accomplished and in 
and in Time the Reunion of the Bone and a Happy Cure.

A Bleeding Vessel, also Point out it Utility, 
for without the immediate assistance of Surgery the 
Patient will Die from the Loss of Blood, the Surgeon
from nearly a fatal End will Restore the Individual,
to his former h Strength, and Health. must more 
might be Said to Elucidate its great Importance are
its Utility. but these Instances Clearly Points it
out, and the best Speaks in Own Praise; Many
People I am Sorry to say it (Consider Surgery under
too different Lights. If Practising only for the 
Sakes of getting a Livelyhood, very little Art
and Abilities are then requir'd, but Considering it as
a great a noble Science it Requires Steady
Applications. Abilities and Integrity; and as You
get this Requisite Acquisition, You will Despise
and Abominate the other; the Surgeon should be well
Acquaint'd wth. Plain [crossed out] Anatomy, that is the Muscular
Parts and especially their Us's, and Simaliar,
when Contract'd and when Relax'd, he shoud under [under???]
the Constitution of every Joint, and the whole of what 
is Call'd the the Animal Œconomy, such as Digestion
from the Mastication of the food, in Passage to the 

Stomach and Stay [illegible] there, and then the formation
of Part of it into the Junction of Bile, and the Conversion
of the food into fœces and Expulsion per Anum, and 
without which he cannot Obtain a Compleat Knowledge
of Surgery. This will Undoubtdly take up some time
it is at the first Difficult, but is easily attaind
by a little Cloose Applicaion, and Perseverance.
A Surgeon shoud not only Know Anatomy but should
have a Competant it Knowledge of Physics and
shoud be very well Acquaint'd wth. the Action and 
Quality of Medicines, As in the Country he cannot 
have the Assistance of Calling in a Physician. A 
Compound Fracture in the first Place will take on Inflamation
and Febrile Symptoms Attending it, which will
Require Medical Assistance, in the last State of it will
from it many Symptoms require a Different and 
Careful Treatment; Surgery not only Consist in Pleuing
the Limb in an Advantageous easy Position or
Dressing or Turning it wth. great neatness and 
Dexterity, this will not Deceive a Patient of his 
Principal Complaints, He may Sink from a Diarrhea
Dysentery or Diabetes, and He must have Medical
Assistance. If therefore Behooves You to be well 

Acquaint'd wth. there the Complaint for the 
Removing of them, or You will kindly annals greatly
Embarrass'd; and from the Meriti that Reputation
which ever Distinguishes a good Surgeon.
Anatomy and Physiology are absolutely necessary
make the Surgeon to there should be added natural
Physiology it ought therefore to from Part of your
Studies, as that will Point out to You the Beauties
which attend the Noble Science, and greatly assists
the natural Genious, and Explains to Us the 
many Divisions Nature sometimes Puts on and
to these must be added, and Temperate Steady
and Resolute Patients Injuring and not Bias'd
by Prejudices, and not to be Led by the first 
appearanc's as Not in Unmanly his Resolution
shoud by no means Lead him to Barbarity or He 
shoud make a Distinction between the Senseless
Dead and Sensible and the [illegible] Irritable
Parts of a Miserable and Unhappy but falling
Patient; thus are the branch in Falling to a Cruelty
in their Operations. Who on reading their Tracing of the 
Spermatic Chord Five or Six Inches up into the Abdomen
for the Removal of Schirrus Testicle and Chord

could ever suppose they ever did it but on an 
Animal Body or that if otherways less than Mad Men
for the Attempt. Now they doe this cannot be Conceiv'd
by a Rational Surgeon, Yet if they Lay this Down 
as a Matter of part, and that have been Produc'd, I can not
Preceive that this has ever been Peform'd but on the 
Dead Body. When a Surgeon Comes in Practise in the
Highest Sphere and is often Calld upon, He must
have other Necessary the Qualifications) An Eye an
Hand and Temper; this Eye is as Gold Pleaser to 
give him, is Hand may if Defective may be Owing 
to himself and his Intemperance; therefore in a 
Surgeon to Live a Temperate Life; His Temper shoud
be mild and be engaging, and not to frighten the 
Irinarous without the Appearance of Brutality
which is always to be command'd, and for a farther
Recital for their a Accomplishment and Necessary
Qualifications belonging to a Surgeon, I will Defer
You to Surgical Writers who have fully treat'd of it,
that a Physician will always be the best Practitioner
who has a a Knowledge of Surgery, and in like Manner the
Surgeon who is the Acquaint'd wth. the Use and Quality
of Medicines, Writers in Surgery may be Divid'd into 
Two Classes those of general System, and those of 

particular Diseas's; the former have not Time enough
to kill as Minute Diseas's they doe little more 
than Give out Lines and Copy from Another; the 
latter You should lead more Attentively, and Pay
always more Respect to Yourself, and Let Your  
own Judgement be always Accompanied wth. this
System Comparing it with Your own Observations,
and Practise Shews to You And then Act accordingly,
Surgery has within these 50 Years been Improv'd very 
much, but Let not that excite Your Vanity, but tend
rather to excite Your Ambition, by Assiduity and
Study farther Improvements, for no Doubt some 
Years hence Our own Successers will be as much 
Astonished at our Ignorance, as We are at our 
Predecesours; Many Useful Improvements, We Owe
to their Use, from wch Fool hardy Practitioners
and Ignorant Quacks; Thus was the Present Later a 
Operation for the Stone, Invent'd by one From Jacques
a Person of no Education. Therefore Knowledge
may be beg of from the Ignorant as well as the Learn'd 

and indeed most of the Useful Discoveries in 
Physick and Surgery have been Effect'd through Ignorance
and Chance. Now Whidaly different is the Small Pox
to what it was a few Years ago, I woud always Have 
in Medicine between the Custom Practise of Religious
well Meaning Practitioners; and the Foolish Variable
Practise of others, nor ever Listen too greedily to 
my sudden New Putting Practise, before You have 
thoroughly Consider'd it; Now with Respect to Your
Studies Compare Your Reading with Your Observations
that You may be able to Form Distinctions and 
Differences, which You may Regulate in Your Notes;
the frequent Dissections of Dead Bodies is absolutely
Necessary, To know the Situation of Parts and 
how Construct'd &c. This will Give You above the 
Rest the sole use of Your Hand in Respect to the 
Operative Part of Surgery, and which cannot be 
Obtaind but by a Dissection. In Performing 
an Operation, always Remember You have a 
Body before You, indeed wth. the greatest Degree
of Sensibility, and wth. the most exquisite healing
therefore Give the least Possible Pain Imaginable

be not too Quick nor Strive to Shew Your
Dexterity, by doing which You may Cut Parts
which ought not to be Cut. but be Calm and 
Let this be a general Rule with You, if its well
done its soon done; I have now only to add, if I shall
Give You any Knowledge in these Lectur's, which
is My Intention to doe; You Oblige me by Improving
it by study and assiduity and then to Practise
as an Honest and Judicious Surgeon- 

Lecture 
On Tumours 1st.
Before the Discovery of the Circulation of the 
Blood and before the general Distinction of the Fluids
through the Body, owing, it was thought the Principal
Fluids where from (viz) Blood, Bile, and Pituatar
and Anobitis, or the Melancholy; and that these when 
and or due Regulation, where not only necessary to, but
even the Source of Health; it was likewise Supposd
that the Redundancy or Dimination of these Fluids
or Numours, was the Cause of Different Kinds of Tumours
Namely Phlegmonous, Erisipelas, Œdema, and 
Schirrhous, that these Opinions are foundd on
Matter of Fact, is hard by necessary to Observe; in
this Place We still keep up the Manner of Distinguishes
Tumours into four Classes, because We find
the Divisions are very natural, and that all four 
Require different Kinds of Cure, the Phlegmond
is not Confin'd to any particular Part of the 
Body, but it may happen any where; Its more or less
a hard Circumsensible & Tumour, it attend'd with [illegible]

Degree of Pain, and Puts on an Inflamatory
Appearance of a higher red Colour, the Patient
has frequently some Degree of Symptomatic Fever and 
commonly is Preced'd by a Slight Shivering in 
Proportion to the Degree of Inflamation; this is the 
common and the most frequent appearance of the 
Phlegmon; but it may from many Circumstances
put on a Variety of Appearances; the Seats of this 
Disease or Tumour is in the Dela Cellulora, or the 
Membrane expanded over or between the Muscles,
for Lubricity, and the Membrana Adiposa, the
former is [illegible] then suppurated; and the 
latter is Partial; so it arises from Obstructing
the Fluids Secret'd by that Membranes, for the 
Lubricity of the Muscles, which it Covers. This
Obstruction Continuing Produces an Induration
which on the Consequence of an Inflamation and 
Suppurating the Phlegmon on Account of the 
Method of Cure is Divid'd to Two Kinds. for were
it is not be Caused by one Previous Disease of the 
Habit, secondly where it is the Normal Termination
of some Disordh of the Habit in general; As for 

Instance the Crisis of a Fever. In the first Place the 
Discussion of the Tumour; should be attempt'd by the 
Antiphlogistic Regimen Emollient Cataplasms and 
gentle Evacuations by the Lancett, and Lenient Purges
and Diluting Medicines; In the Second Place We
ought to Make [cross out] Use of every Method in Our Power; in
Order therefore to Carry of the Disease; for this Effort
of Nature might Prove Dangerous or even fatal, and 
Discussion is to be attempt'd by Means so well and 
generally known, that it would be needless here to Point
it out the same may be Paid wth. regard to be the Methods
to Promote Suppuration, when the Matter is Completely
form'd in the Tumour, thus because the swelling could
not be Dispers'd or because it was thought proper to 
Promote Suppuration, it is undoubtedly to be 
Let out, but the Manner in which this should be done
has been a Matter of most Controversy. Our
Forefathers did it by either Omission or by a Caustic
the latter was more generally Us'd, because by this 
Means the Matter was more Effectually Let out of 
the Abscess; on the Account of the Opening they made
but in this they do not seem to have any great 
Regard to the Pain Occasiond be, this Application

of the Caustic and the Indelible Sear Necessarily
Left behind; when they open'd by the Knife it was 
Customary to Cram the Sore with Lint, afterwards [cross out]
Using not Medicines as they thought Promoted
Suppuration, [illegible] the Contrary when not at all
Calculated for it, by this Means the sore was Surround'd
for a Considerable Space with Inflamation, therefore 
what Contribut'd to the Opening greatly of the Abscess
by Caustic was that there who made use of the 
Knife did by their Erroneous treatment of the Sore 
afterwards; and this then brings their Method into 
Contempt and Disrepute; Incision is much the best
and what I would Recommend to You. This either
making a Puncture or a large Opening wth. a Stroke
of the Knife will Answer the End, You Arrivd at
which is only to Evacuate the Containd Matter, and 
this will always be found the most Useful and Beneficia
to the Surgeon or the Patient they thought that 
the Cavities of [illegible] [illegible] made by the 
Destructing and therefore they thought that they 
where to fill it up again with Flesh and Us'd such

Medicines as they Call'd Suppuratives and
Digestives to Promote this End; the Method Brought on
all those Evils which they Want'd to Avoid. The 
Use of the Caustic they Imagind was a Specific and 
after Leaving the Eucher to Slough off they form'd
the Cavities filled up, and therefore without Considering
the true Reason they Preferd the Caustic, for when the 
Application of Caustic was Us'd they never fill'd the 
Cavity with their Suppurative Medicines Lint &c. He 
is well Known that Matter is Form'd by the Melting Down 
of some Membranous Parts, but this Been a very
small Proportion indeed to the Quantity Form'd of Matter
and Nature herself as soon as the Matter is Let out to 
Contract the Cavity. And We only are to take Care of the 
general Health, and to Maintain such a Opening
as to Present a Judgement of Matter; for the Sear of the 
Matter is often out of the Beast of Our Dressings
and Yet Nature Comes through Abscess as herself. Then
this We find from the filling up the Cavities of Abscesses
with Lint and the Escharotic Dressings was truely
wrong and Prejudicial. And that soon if we where not to 
Apply any Thing the Cavity will be Contract'd.

And upon the whole, We may Allow that the 
Application of a Caustic is hardly even to be Us'd; In
[illegible] simple Phlegmon, the fever generally, Ceases
on the Formation of Matter, but as this do's not always
happen the Assistance of Physic is Necessary; Inflamation
do's not always Terminate in [cross out] either of these two Ways
but sometimes End in Gangrene and Mortification, this 
is generally attend'd wth a Disease of the whole System
when the Habit is Mended and the Gangrene Superficial
Nature herself will Throw it off but when the Part
is entirely Speculated it requires Changes to get 
rid of it, when the Gangrene Succeeds great Pain
and fever &c then We are able to Say the Gangrene
has spread more Internally than what appears 
externally, and if the Operation of Amputation must
be Perform'd higher than the Part Gangrened; and 
the Part Mortified Separates Considerably
above the Discolouration, and is Discharg'd into 
the Cellular Membrane, and always up above
the Mortification. The Operation must not be Stop'd 
before the Mortified Part begins to Separate
for the Mortification can never be Stop'd by an [illegible]
We should above; Attend to the Patients general 

Habit and Counteract such Symptoms as shall at 
the Time Occur, either by Evacuations or the Contrary
and if there is a fair separation Obtaind in 
Consequence of a fair Suppuration Establish'd
this will Point to us the Place where we shoud
Amputate and We should always Wait for this 
not Amputate (as was the Custom of our 
Forefathers, at the Place above for the Reason
of having a good Stump for the additional 
Pain and Consequent Inflamation is very likely
Mortification apart and will often Infallibly
Destroy the Patient; Scarification is thought
to be little more than Scratching the Skin, but 
Gives Pain to no Purpose) If it is meant
to make large and deep Incisions it may 
possiby Discharge a Putrid Lanias and 
Unload the Limb. but it is not Known that
Produces any Sensible Effect. The Erisapelas is 
suppos'd to be Produc'd by Bile it is formd in 
Bilious People and it requires a different 
Treatment from the Phlegmonous. it is commonly
flat and Broad and spreads to a Considerable 
Distance and has not the Scarlet appearance of the 

Phlegmanous and is not so elevat'd or Point'd and 
is generally attend'd with Vesications when large it is 
generally a Disease of the Habit, this Inflamation
may Proceed from Two Causes (viz) either from
too small a Secretion of the Bile, as too great
a Distribution of it, the Causes which may be 
Productive of the Secretion being Imped'd, or 
from an excess of Drinking of Spirituous Liquors
and Debauches of Various Kinds which are the 
Consequence of an Indurat'd Liver for from 
a Salivation, or from a Weakness of the Parts from 
Disease. The Tumour is generally of a Paler
Colour tinged wth a yellow Cast. The Method of 
treating this Disease is to Strengthen the Patient
wth. Cordials Stomachics Medicines Join'd wth. Chalyts
in Order for to Remove the Obstruction and 
to Promote Secretion of Bile, On the Contrary
you must Promote the Suppuration. The other
Kind Arising from an overflowing of the Bile into 
the Stomach Duodenum and Jejunum and is of 
a more yellow Colour. It is generally Accompanied
wth. a fever, there is thirst Amnesty and Nausea
and Inclination for to Vomit and a dislike to food &c.

Neither Dissolves or tends to Suppuration We should
be Careful of the Means Us'd to Dissolve it, when a 
Disease of the Habit, We should Endeavour to Divert
the Bile by Lenient Purges Calculat'd for that 
Purpose, and also to be Careful in Evacuating, wch.
shoud be Done wth. great [illegible]; for it may be translatd
from the external to the Internal Parts, and We ought 
also to attend to the Natural Strength and Pulse
of the Patient, and take Care not to Impede the 
Circulation already began this Method of by
Discussion for ought never to [illegible]
and we are to Promote suppuration when Nature
Seems Inclin'd for to Produce Matter, it is always
to be Encourag'd, there is no method of Discharging
the Matter but by a proper opening of the Matter is not 
then Collect'd in that Circumscrib'd Manner, as in
the Phlegmonous but is left [illegible] in more Places
and the White Cellular Membrane, in a Diseas'd
State and Sloughy two or three or more if necessary 
sometimes the Strength of the Patient is renderd that 
when the Sloughs are separated the Sore has not a 
good appearance. Means the Habit by proper
Medicines and Diet will in good Time enable
Nature to make a Perfect Cure. The Œdematous Tumour

Tumour arises from the Pituitous State of the 
Blood and Juices generally Seat'd in the feet
and Leg's, they are sometimes seat'd in the 
Legs wch. have been Broke, and is Proceeds likew
from an Obstruction in the Absorbant Vessels,
from the Situation of the Leg not being able 
to Perform it Office from time from the Use
of it the Vessels will Receive Elasticity and 
Perform their office, but if it do's not Disappea
the Advice of a Physician is necessary to Remit
the strength of the Patient. The Bark and either
Cordial Medicines Join'd wth. the Chalybeates will be 
found most hope, the Schirrous Tumours. The
Ancient Us'd for to Receive all Indurated Tumours
under this Head but [In?delemus] give that name
taken but that will not admit of Suppuration
by any Means whatev'r; And may justly be Calld
Schirrous or Cancerous, for they are liable to be 
unstated into Cancerous by any slight accident
or a Blow or a Fall, or even the Disposition
or Distraction of a Persons Habit, there are two
Methods Prepar'd for the Removal Extirpation
and Disfaction, the Ancients Recommend'd the 
Caustic as a certain Cure. Duct for my Part

I recommend and Prefer the Knife as I have before done
to your Use; the former is certainly Provid'd you are 
certain of in doing it Business Effectualy, a very
Excruciating Painful Remedy; not let the Patient
who are afflict'd would much sooner suffer the Pain
than Labour to the operation by the Knife and 
Arguments Us'd to Persuade them of the difference
wth regard to the Pain, and the Time of Respiration
is frequently fruitless; the Knife to the Surgeon
who dos [cross out] Know how to Use it, and the Parts he 
is to Cut on, most certainly is Preferable, who 
can Extirpate what he see's is Necessary, and Leave
which is a principal thing as much Skin or will
Collapse and Heal, and having Left but the Remains
of small scar, whereas the Caustic is Productive
of much Pain it totally Darkens the Skin, and what 
is Worse its very apt to doe more in Spite of all
your Efforts to the Contrary; We intend'd to have mentiond or ought
to have done their never has been found was
any Internal Remedy for the Relief of those Tumours
the only one is this Propos'd.----

Lecture 2d. On Wounds
Wounds are by the old Writers Distinguish
into four different Kinds, Incision; Laceration, 
Puncture; and Contusion but in Order to Give you
a more Clear the Idea of them I should Describe
them under the following needs.
Just those which are necessarily Mortal
2d. those which are not in Themselves.- 
Neither Mortal nor hazard one but by Neglect
becomes so; of the first, then are Wounds on the Lungs Near 
Cerebrum, and Medulla Oblongata, Aorta Vena,
Cava Receptaculum Chylic, abd Ductus [Thoracic??]
Those of the Second are the Liver Stomach,
Pancreas and Mesentery, the Spleen and Kidneys,
Those of the Kind Inclind to all Slight Wounds Inflicted
in any Part of the Body; the Method of treatment
and Symptoms attending [cross out] those several Kinds of 
Wounds; of Wound shall omitt until I hear of then
Distinctlly, recent Insis'd Wounds, our first 
Intention must be to Procure a Union of the Divd'd Lips
of the Wounds' I have heard by different Writers
on this Subject several Methods Propos'd and likewise
different Sutures a Description of which you
may see in Kaister and other Authors; the 

Interrupt'd or the Common Suture in those slight
Wounds is the best, Not but the Day one may
sometimes be Judiciously Us'd, as in the Jaw and 
others Parts which are Expos'd, Deformity should be 
Avoid'd: We are Advis'd by French Writers before We
bring the Lips together in Order to Constringe the 
Vessels to Apply a little Allum finely Pulveriz'd or any
other Astringent Powders, but this Method will
certainly Irritate their Intention, by Acquiring a
Suppuration to Cast off the Gramous Blood Clott'd
together by means of the Application, and rendering
the Wound from Healing by the first Intention, which it 
certainly will doe if You Procure the following
Method, after having Examin'd the Wound, and 
found [cross out] of there by any extraneous Bodies, as Dirt &c, which
may have Accidentaly get in to it. You are to
bring the Lips of Wound in to Contact; and in
that Position You are to make Your Suture, and 
Cover it with a Pledget; It is the best Way to make 
a Slip Knot, as You may by that means easily
Remove it, but it sometimes happens from the 
Patient Jandancy to Irritation and Inflamation
that [cross out] these Slight Wounds will be attend'd
wth. much Pain, and Inflamation and some
Degree of fever; [cross out] wch. will require some Attention; 

Our principal Endeavours must be to abate
such Symptoms by Phlebotomy, Lenient
Purges, Opiates, Saline Draught, diluting
Liquids and the Like; and likewise the proper
Position of the Limb or Part of the Body Wound'd.
The Prevailing Practice of London Seems to 
Deny the Use of Sutures thinking them that of Useless
and Painfull Methods; but I do differ from [illegible]
own Experience, there who Decline the Use of Sutures Lay aside 
every Useful and Advantagous Part of the 
Art.-- In Lacerated Wounds it may sometimes
be and if You are Cautious and Say come mention
the Strength and the Situation of the Wound, for 
tho they certainly differ from Incis'd Wounds
yet there are some Inflicted Rarely resembling
them; the same Method is to be Pursued, those
Wounds are generally Attend'd wh agrees Degree
of Inflamation; and such Regime greater
Attention, where in large Wounds of this Kind, tho
there certainly is a less Substance whereby the 
Intention by Means of the suture is Frustrated
yet are of Use in Contracting the size of the Wound,
and in some Degree hasten the Cure; If the 

Wound will not Heal from the Loss of Substance
by this Method, [cross out] Consequence Attending
this Method is Trivial, for it will not add to the 
Inflammation, nor retard the Cure; The Suture will
bring the Lips of the Wound more in Contact
and the proper situation; and half of the Bandag's
You will be able sooner to Compleat a Cure. [cross out]
Wounds made by a Puncture are in themselv's inconsiderable
but are Liable to Prove otherways by the Patient
Constitution, the Inflammation, the Symptoms sometimes
Attending them are very Alarming, A Wound Inflicted
on the tendon of the Biceps Muscle, or any other
We frequently find, is Attend'd with much Pain
Inflammation and Rigidity of the Limb from the
Carelessness of the Patient, and from a strong
Position of the Limb, the Surgeon is to Inquire
how and by what Instrument, it was Inflict'd; And
then Proceed to the Patients Relief; if the Part which
is Affect'd be much Swell'd, and Inflam'd and 
attend'd with some Degree of fever and Pain
keeping the Body Open, the Exhibition of Saline
Draughts and Plenty of Diluting Liquors, VS.
Placing the Limb in a Balanc'd Position and [Apply??]
Emollient Cataplasms should be Continued until 

the Symptoms Abate, but after all these Attempts
Us'd the Symptoms instead of Decreasing Increase
and the Limb threatening a Mortification, the 
Use of the Bark Join'd wth. Cordial Volatile Medicines
Antiseptic Fomentations, Cataplasms are to be 
applied to the Part We may by Rare Means Hope
for Releif, but the Disease still Continuing the 
only Resume will be to Remove the Limb.
Of Contus'd Wounds, Those Call'd Gun Shot Wounds are
the most Violent, and under this Head it was the 
Prevailing Opinion, that no Person who had
not been Abroad, And Attend'd Wounds of this Nature
ought not to Presume and indeed were Deem'd 
Incapable of giving any Releif to the 
Patient; the Ancients Support'd that the 
Powder and the Materials wth. which the Wound
was Inflict'd Carried with them a Poisonous
Quality; from this Erroneous Positions, and being
Influenc'd by this Opinion they Treat'd the 
Patient directly Contrary to the Method I shall
Relate in Order to Guard against the Poisonous
Body they Administerd high Cordial [illegible]
Medicines and Aromatic Fomentations by which 

Means they encreased every Symptom of the fever,
Tension and Inflamation, The Practise I make Use
off in the Cure of these Kinds afterwards in the 
following, having Inquir'd wth. what Kind of fire Arms
they were Wound'd or the Wound Inflict'd, and in what 
Position the Patient was in at the time, and likewise
what the Peice was Load'd wth. You are then Carefully
to Extract the extraneous Bodies there in Lodg'd
but in these Wounds tho they have admitt'd
a Bullett, the Muscular fibres from the Irritation
it Causes generally a Contraction, and You will
Scarce be Able to see the Parts were it Enter'd.
In this Case it will be proper to enlarge the Wound,
if the Part will Permit, which You will be able
to Judge from its Situation, and with the Help
of a Pair of Forceps Extract it; but it happens sometimes
that it Enters so Violently, that it may by making 
an opening be much sooner and easier Extracted
on the Contrary Side almost through the Limb; having
Cleaned it as much as Possible the next thing
Propos'd is Dressing, which must be very Softend
Lenient; and entirely freed from any Irritating
Quality, the Digestion, the Balsam of Bartholomeus
Hospital Applied to the Wound and Covered
with some Warm and Relaxing Cataplasm
will Prove.-- 

Serviceable, and must be Continued some time; there
must be also some Attention Paid to the Inflammation
which must be by, Bleeding largely, Glysters
Given Occasionaly, with Plenty of Diluting Liquors,
Observing a Low Regimen, and not forgetting
Opiates to Appear the Pain; after a Plentiful
Suppuration Comes on, The Bark may be 
Prescrib'd wth. Success. If any of the Vessels
should be Divid'd You must first take Care to Secure them
by a Ligature before You Attempt any 
Application, a great deal has been Said
Concerning the Method of Stopping Hemorrhages
there has been Four Methods Prepar'd (Viz) by Pressure
Stypticks of Various Kinds, the Needles, and 
Ligatures, and by the Cautery, in some 
Cases Pressure may doe very well and 
certainly do's when it is gently Us'd, but 
it is too often apt to Occasion Mortification
by a too Strong and Continued a Pressure;
Styptics may sometimes be of Service, those 
of the Escharotic or Corrosive Kind are Prejudicial
and ought never to be Us'd in small Bleedings
I have made a tincture of Gall Nuts in the 

Rectified Spirits of Wine, and Balsam Fraumat
which has been very Efficacious; the Needles and Ligatures
are by far the best, and inert Method; and what 
I would Recommend to Your Practise, always
take up the Vessels as Naked as you can. And
never Include the surrounding Cellular Membrane
for as that begins to Suppurate, the Ligature
becomes Loose, the Artery will again Dilate and 
You will have a fast Hemorrhage [cross out], which will
now perhaps be very difficult to stop. As by the 
Last Method by the Cautery it is too extremely
Painful and highly [cross out] Unnecessary, and that is 
now Universally Explod'd. 

Lecture 3.
On Fractures
Fractures are by Surgeons both Ancient and Modern
Divid'd into two Kinds', Simple and Compound; what
is Meant by the Simple Fractures is when there 
is a Division of one or more of Bone or Bones,
without any external Wound; And a Compound
Fracture is a Division of Bones, and a Wound
Occasioned by the Protrusion of the End of 
such Fractured Bones; I shall in this Lecture
only treat of Simple Fractures. A Simple
Fracture may be Caused by Various Accidents
as Falls Blows, and which by proper
treatment and Care may easily be Reduced
and Cured; Our Predecessors where of Opinion
that Broken Bones coud not be properly
Reduc'd unless an Extension was made, that would
force the Resisting Muscles, and bring the Ends
of it in a Straight Line, but seperate but afterwards
Suffer'd it to Come into Contact by gradually Relaxing 
the Muscles, this was their general Opinion and 
as such Put in Practise. After having by Extension

and Counter Extension having Plac'd the Ends of the 
Bones in Contact, the Assistants who are Direct'd to keep
it in that the Extend'd Situation, till the Bandage
Plaisters and other Necessary Applications where made;
the Surgeon then having Felt the Ends of the Fracture
wth. one Hand, and gradually applying an Adhesive
Plaister wth. the other, which they thought woud
Act as a Discutient. Next to this they Us'd to 
Apply the Circular Bandage, and to that where 
Plac'd Four Splints, which where made very 
short, to Answer the Purpose as they thought of 
keeping the Ends of the Bone even, and in Contact
and Lastly after every Kind of Compress, a Banadge
as they thought Necessary for the Security of the 
Limb was Applied, and it was rest'd in this Extend'd
Position in a Fracture Bone, made of Wood whose
bottom Lies in a direct Plain. wth. sides to Prevent
the Clothes from Pressing it. As I have Now given 
You a Description of Our Forefathers Practise,
and which I am Sorry to Say it, is still Continued
by some. I shall take the Liberty of Relating 
it to You, the most Safe and Effectual Method
of Reducing and of treating Fractures whether
of the Leg or thigh. Having Put Your Patient 

to Bed and Prepared Your Apparatus which 
are a Pillow and Eighteen taild Bandages a Flir
of Plaister Tapes and Cradle; You are to Place
the Leg so as to have it in a Balanc'd Position
upon the Pillow; and if from Placing it thus the 
Ends of the Bones are not in Contact, which 
generally You may wth. very little Extension
Replace them, this done You are to Apply Your
Plaister on it, the Bandage, and treat the Splints,
which must be only two in Number, and Long
enough to Serve both Joints, which is the Intention
Meant by them; these are to be Lined with [??w] or 
any other Soft Substance, to hinder the Pressure 
on the internal Malleolus or external Condyle
then Secure the Limb in the Pillow by tapes
around to Place over it to Prevent the Pressure
of the Bed Clothes Your Cradle. It will be 
proper to Bleed Your Patient and if Costive
Order him a a Glyster, the Advantage Arising
from this Kind of Treatment is Obvious;
Placing it in a Relax'd Position certainly
Prevents Tension, and Inflamation; and the 
Muscles are thereby hinderd from Acting. The
Plaister which should be applied shoud be of the 

Repellant Kind, much as the Carat Sapon of
Bartholomews Hospital or the Application of the 
White of Egg's and Acct. Spirits of Wine alone or 
Mined wth. Vinegar and Spiritus Minder; all these
are very proper and much more so than the Applications
they Us'd, which where Exp. Robor; Piris; which are apt
to bring are a Necpes and Cause Violent Itching.
The Bandages he recommends are certainly
very advantageous, As it do's not require the 
Disturbance of the the Limb, which the Roller
do's and must Impede the Formation of Callous,
And this Position of the Limb will Admit of the 
Applying of Cataplasms, full as well as the 
other. The Splints are Mentioned before, and must 
be large enough to Secure and keep Steady
both Joints, and may be fasten'd in the Manner
Propos'd; and You must likewise Pay some
little Attention to the Situation of the foot.
Taking Care sufficiently to keep the Bone Level.
This Method strictly Observ'd will have the 
Desird Effect.---  

Lecture 4th.
On Fractures Continued.
Having in some Method Describ'd to You the treatment
of Simple Fractures and the Applications proper
to be Us'd. I shall now relate a few particulars
on each Bone. If the Clavicle be Fractur'd We
are Ordered by our Ancestors to make a sufficient
Compress on the rising Ends of the Bones so as to 
Depress it, and bring the rising Ends of the Bone in 
Contact wth. the Inferior End. but this Doctrine
is Absur'd, Erroneous, and Impracticable; for 
were You to Press ever so great a Weight upon
it, You might Crush the Bone; but would never
answer Your Intention. in Depressing it.
The Clavicle is fix'd to the Sternum and Scapula
by a Ligamentous. Articulation for keeping
at a proper; Distance the Scapula from
the Body; thus when Fractur'd it is always 
Depressed at the End Articulat'd to the 
Scapula from the Weight of the Stone falling
inwards its evident that the former Practise
is Erroneous, and that which they form the 
Chiding End is truely on its Place the 

the only Method of bringing the two Ends into Contact
is to Elevate the Arm until You find the surface of 
the Bone even, then to Apply a Plaister of [illegible]. Supor
wth a small Compress of tow, Securing it by a 
Bandage wch. is to Crop the Bark and Breast
in such a Manner as to keep the Shoulders Back
and Breast as much as can be allow'd of for the case of Your
Patient not forgetting to keep your Patient arm
Elevat'd without which Your other Applications
are fruitless. In the Inactiv'd Tumours; for the 
Reduction of which You are to Relax the Muscle
of the fore Arm, or they will Prevent the Antagonist
and translate your the Intentions, tho You should
Use great Extension, to bring the Ends of the Bone
in Contact; the Method of Reducing it is this 
is to Bend the Arm Setting the Patients Palm
of his Hand be on the Breast. And then if Requir'd
make Your Extension, then Applying Your Cerate
and Bandage either the Eighteen Tailed or Circular
keeping the Arm in the same Position. In a Fracture
of the Arm or, of the fore Arm either of the Ulnar the 
Radius, We are to Consider that We have not
only the Muscles which Perform Flexion and 
Extension, but Pronation and Supination,

and therefore the Arm must be so Situat'd as 
to give these Muscles no Cause to act, having
Relax'd the Muscles by Placing it on the 
Patients' Side, and Rending; You are to
Remember) to place the Patients Radius
upwards, to Place the Palm of the Hand to 
the Patients Breast. and make whole extension
may be Required. after that Apply Your Cerate
Bandage and Splints, Placing it in a Pillow
Secur'd by a Sling in Order to keep the Arm in 
the Direct'd Position. In the Fractur'd Femur
having Put Your Patient to Bed, and Plac'd
him in an easy Position on the Side which
the Fracture is, You are than by Relaxing the 
Muscles of the Leg, to Lay it in an Oblique
Position, And in that Manner make Your
Extension, having got at the End of the Bone
in Contact, You are to Apply Your Bandage
and taking Care to Place the Knee in such
an Elevated Position, as will keep them
in Contact. For a Fracturd Tiberias Tibula
the Leg is to be Plac'd in the same Relax'd
Position, as is above Mentioned. But it sometime
happens there will be a Fracture of the Tibula

wth a Dislocation of the Tibia. which is a Case which
her Perplex'd Our Ancestors much. And by their ill
Treatment made them liable to very Disagreeable
Consequences. Having [cross out] Seen several wth.
very Alarming Symptoms, they Us'd to Place
the Limb in an Extend'd Position, and as they Laid 
Reduce the Dislocation, by making a most Violent
Extension, which was the Practise and wch. is ever to be Condemned,
all that is to be done in this Case is to Lay the 
Limb in such a Position as for a Fractured
Leg, by that Means You Relax the Muscles
and Ligaments Surrounding the Joints, and 
in a great Measure Replace the Mallastus 
Internus which was thrown outward. In this Case
the Tibia is thrown off the Astragalus and the 
Ligaments are Lacerated; but by this 
Method, And Attending to the Symptoms
and Positions, You may Promise Yourself
a Happy Cure. There are Two Fractures in 
the Human Body which Require the Limb 
to be Placed in an forehand'd Position, which 
are these a fracture of the Olcranon and 
the Patella, the Position keeping the Ends
more in Contact, than in a Relax'd or Bent one
[illegible] than Extend'd either the Arm or Leg 

You are to Apply Your Cerate, and Circular
Bandage, Keeping Your Patient at Rest. It
sometimes happens but from what I know 
not or cannot Determine whether its either from too small
a Quantity of the Ossifying Matters or the 
Patients Constitution, that after the Patient
has Kept his Bed for Six Weeks or Two
Months, that the Bone will not be firmd
have Seen this Twice or Thrice in the Os
of the Humeri more in that Bone than in 
any other in the Body. If this should happen
the Method I should advise, and which I have 
found most Useful /is this/ to Let the 
Limb Hang in a Depending Posture for about
the space of an Hour, and to Mind the 
Patients Habit by the ordering of Cost Peruv.
The Relax'd one or Two Cases when the Callus
in a Carinate Patient Produc'd a Caries of the 
Bone, and Loss of the Limb, and when the 
Limb was Remov'd the Cancerous Veins
Attack'd the Viscera, and the Patient Died.
In all Fractures there is a Symptomatic
Fever more or less and some Degree of Tension
according to the Habit of the Patient; You
are to Attend to those Symptoms, and Obviate them

by such Evacuations as You shall Judge necessary
in Pletheric People, You will sometimes have 
a Violent Tension, and Inflamation; and in
Gouty Patients, very often a Violent F.H. which
is a very Disagreeable Circumstance. In all these
Concomitant Symptoms You must Pay the 
Utmost Attention, and make Use of such means
as will be most Productive of Your Patients
Safety, And Your own Reputation. In the
first the Antiphlogistic Regimen will Answer
Your Intentions; In the Second Medicines
and Fomentations Calculat'd for such Disorders
and to Divert the Symptoms attending it.

Lecture 5th.
On Compound Fractures
A Compound Fracture is Produc'd by the Protrusion
of the End of the Broken Bone, through the 
Integuments Covering it, Causing a Wound, whether
large or Small, I shall first treat of one which Requires
very Judicious Treatment, which every honest Man
would Exert his Judgement to Know whether such a 
Limb is Capable of being Sav'd without hazarding the 
Patients Life. In a Fracture, where the Bones are
Broken very Obliquely and at the same Time Protrudes
so as far as to Put it out the Surgeons Power
to Reduce it. Join'd at the same time with a 
Violent Laceration of the Parts; in such a Case
undoubtedly the Operation will be Necessary.
It is impossible for the most Experienced 
Practitioner to Determine whether such a Limb
may not be, but it is certainly most Prudent
to Remove the Limb, in these Circumstances
You run a Hazard of Your Patients Life, for 
in this Case there is no time to be Lost, from the 
Circumstances of the Case must be Urgent.
The Symptomatic Fever must be great and an 

Impediment to the Circulation must be the Consequence
from the Laceration. The Second Case is when the Bones bear
much Crushed or Broken and the Surrounding Parts
so much Build by the Weight, as to Put an End
to the Circulation; this as well as the other will Require
the Operation. The third Case which will Require
the Operation, in having Attempted to Save the Limb.
The Inflamation Notwithstanding You have made Use
of every proper Method, so as to bring on a Gangrene
and then Mortification. Remember this Circumstance
that if You have not Removed the Limb before the 
Mortification has began to Spread; and that Removing
while Spread it will Destroy the Patient, as it will
by no Means a Stop the Putrid Virus, therefore
it behoves every Person to Assist Nature, by such 
Means as will Cause a Separation of the Diseas'd
Parts. The Symptoms Arising on the first Case
are. If the Limb is not Remov'd in a very short
Space of Time, Violent Symptomatic Fever Attend'd
wth. thirst a Parch'd Brown Tongue, and very frequently
a Diarrhea. The Limb at the same Time in an 
Inflammatory State, these symptoms may Continue
two or three Days and then instead of Inflamation
the Limb will Put on a speculated] Appearance 

the Fever is then increased and Attend'd with 
a Singulous and with a Delirium, and frequently
Fetid Stools and wth. Colliquative Sweats, and Death
inevitably the Consequence, An Instance of this Kind
I lately Saw in the Hospital. Where the Tibia
and Fibula where much Broken and the former
Protrud'd, and so much as made it Impossible to 
Reduce it Mr Pitt advis'd the Man to Submit to the 
Operation, but he absolutely Refusing at the 
End of four Days he Died, in the above
Described Symptoms, frequent Bleeding was 
made Use off. and likewise Lenient Purges and 
Glysters so as to keep the Body Open and 
and Abate the the Inflamation; the Bark was 
Administer'd, [cross out] when the Limb Put on the 
Sphacelat'd Apperance. The Volatile juleps
was Join'd wth. it. The Limb was Foment'd with
the Aromatic Fomentation, And a Poultice of 
Wine Les was Applied and Oatmeal. The 
Symptom from the Second will be the same but 
whether they will be so evident soon, I cannot 
Say; but it is very Evident that a Limb
Join'd and Bruised in such a Manner will not 

Admit of the Reunion of the Pieces of Bone, nor 
can We ever Expect the Circulation to be Carried on,
If not the Hemegnance must be from Gangrene and End 
in Mortification, which will have its Concomitant
Symptom's and Destroy the Patient as in the 
preceeding Case, the Method Us'd must be the 
same. And if the Pain is Violent in either Case Opium
must be Employ'd and wth. Success. In the 
Third Case when the Limb has gone on for some Time 
favorably by the Methods which have been
Us'd, it will sometimes happen from the 
Natural Tendency of the Patients Habit, that the 
Inflammatory Symptoms will Return wth more 
Violence than at the first, and all future Attention
will Prove Fruitless. Its still increasing the Limb Put
on a Gangrenous, Appearance, and at Length
Mortification; then it will be Necessary to Assist
Nature in Separating the Morbid Part from the 
Sound Parts, by the free Use of the Cortex, Join'd wth. Aromatic
Medicines; If You can by this Means so far keep up
the Vis Vitae, so as to Cast off the Morbid Parts, and find
You have Stop'd in Progress, than the Operation
will be Necessary on that Part of the Limb it is to 
to be made, the situation of the Parts will Determine 

having treatd on those Fractures which will Require
these Operation shall Relax a few Particulars
on those Symptoms which are more Lenient
We will Suppose a Compound Fracture Caus's 
a small Protrusion of the Ends of the Bone,
And Attend'd which is sometimes the Case wth.
a great Degree of Tension, and Inflamation; all
that is Requir'd is to apply a Pledgit of Cerate,
and the same apparatus as in the Simple
Fractures, but sometimes it happens that the 
same Case, shall be attend'd wth. a great Degree of 
Tension, and Inflamation and Pain, than it will
Require You to Attend Strictly to the Symptoms
and Alleviate them, by such Means as will
Avoid Matter Forming, and hindering the Wound from 
bleeding by the first Intention; To Accomplish this,
Bleeding, the Application of Emolliment Cataplasms;
And if that do's not Answer Your Intention a Weak
Solution of Sal Ammoniac will be proper
likewise Spiritus Minder. Vini Vingear, may
be Applied in the [cross out] [illegible] Cataplasm or after
it has been than Us'd; [cross out] the Inflamation shoud
increase and some Degree of Symptomatic Fever
Attend him repeat'd Bleeding will be proper

If the Pulse will Admit of it, Not Omitting Saline
and Nitrous Medicines. If nevertheless Matter shou'd
be form'd it will be Necessary to Assist Nature, by an 
Emollient Cataplasm, And when a Sufficient Suppuration
in Produc'd to make an Opening in the most Depending 
Part of the Limb; In large Wounds of the Joints, when the 
Capsular Ligaments are Wound'd and a great
Quantity of Synovia is Discharg'd, the Consequences
are generally Inflamation and Gangrene, which render
the Operation Necessary-----

Lecture 6th.
On Luxations
Luxations are Caus'd by Various Accidents, and the 
Knowledge of the Part is Requir'd to be well Understood
in Order for to Qualify a Person to Reduce them.
In Order for to Know this I would Advise You to
Direct the different articulations of the Body
and Pay great Attendance to the thin Ligaments
and Cartilaginous Appendag's there to be longing.
If You are to Remove the Muscles Surrounding the 
Joints the Barral Ligaments woul'd be Joined
in some Incapable of Supporting it in its 
proper Situation, therefore the Origin and Insertion
of the Muscles ought to be Known, and Understood
without which it will be Impossible to Reduce
it wth. ease to Your Patients and Satisfaction
to Yourself. for the Relaxation of the Muscles is 
of Infinite Service in the Reduction.
The Os Humeri may be Dislocated either Inward
Laterally or Downward. it sometimes happens
that the Head of the Bone is thrown under the 
Pectoral Muscle, in the Reduction in this Case
instead of Extending the Arm, and bringing it 

from the Body, You are to keep it near the side and 
Relax the Muscles by Banding the Fore Arm, by that
Means making so great an Extension, as well
bring the Head of the Bone more forward on the Edge
of the Cup and then give Way, and by the least
Elevation of the Bystanders it will immediately
goe into its Place. If the Accident has happen'd
that the Method a Practitioner is able to make the 
off wth. the Hands will not Succeed. I would
Advise you always to Apply Your Towels, or what
ever else You Intend to Use for Your Extension
at the lower End of the Bone, keeping the ForeArm 
Bend'd as by this method all Your Force Applied to
that Bone alone, for if You Apply it as some 
Authors Recommend one Towel on the Luxated
Bone and the other on the Joint below the extend'd.
Force, on the lower is Cast on the Ligaments
which Articulate it to the Luxated Bone they 
Yeild to Extension----- 

Lecture 7th.
On Wounds of the Head.
Whoever will give themselves the Trouble to Reflect on
the Structure and Mechanism of the Cranium and its 
Contents, will Necessarily See the Numerous ill
Consequences, Attending Wounds Inflicted on the 
Head and; Scalp Consists of the Cutis, Tela Cellulosa
Muscular Expansion of the Frontal and Occipital 
Muscles within Tendinous Appendanges, and the 
Pericranium which is Expand'd over the whole
Surface of the Cranium, the Vessels of the 
Internal Pass to Pass through to Anastomose 
wth. the External, If You are Examine the Dura Mater
of those who have suffer'd any Violent Death,
You will find a Number of Bloody Points on the 
Surface of this Membrane, which are the Orifices
of Dilat'd Vessels, I need not mention the 
Treatment of a Simple Wound of the Scalp
as every one knows how to Treat it, but 
it sometimes happens that a great Part of the 
Scalp becomes Detach'd so as to hang Down
like a Flap, this may Arise from the Passage

of a Coach Weal over it; from the Appearance these
Wounds make, It has been the Opinion of some 
to remove the Portion of Flesh should be Remov'd, which Practise
Mr Pott Disapproves off. One Object besides many
others, is that when this Separated Portion of Flesh
is Removed the Patient will never have any 
Pain there Consequently the Patient must ever remain
Bald those Circumstances ought to be Consider'd
therefore the general Doctrine, can Stand upon
no other Foundation, than this where the Suture can 
not be Appli'd, It is very Obvious that all 
Extraneous Bodies, as Dirt &c must be Removed.
If a Suppuration, shou'd happen the Scalp
is by no Means to be Removed on this Account
If Matter be form'd You are wth. Your Lancett
to Let it out, I am of Opinion that a Suture
in most Wounds is best, even when the Scalp
is Lacerated, and the Bone Laid Bare, and 
You should never remove the Scalp except
in one Instance, where You have such Symptoms
as Indicate the Application of the Trephine
than Necessary. It sometimes happens that Puncture
the Skin the Tela Cellulosa, the Aponeurotic

Musclar Expansion and the Pericranium wholly
Injur'd. If the Tela Cellulosa be Wound'd or Injur'd it often
happens the Wound. Puts on a Puffy Appearance
and Vesications Containing a Yellow Colour'd Serum,
there are of the Erisepellatous Kind, and their 
Appearance will sometimes happen in 24 Hours
after the Accident, happen'd it; and will appear
in this Case as if it Proceed'd from some Internal
Cause or Injury but it do's not, although this 
Patient will have such a Nausea at his Stomach
and frequent Vomitings, these Kind of Symptoms
happen in Bilious Habits, it must be Treated
after the Manner of an Erisepellatous Disease
Evacuations by Bleeding Lenient Purges
and Anodyne Poultices, will be found Serviceable
these Cases where well Known, Hippocrates
who Warns the Reader to be Careful in not 
Mistaking this Disease by Supposing it greater
than what it realy is on from some Injury done to 
the Internal Parts. It sometimes happens, that where 
the Muscles and their Tendinous Expansions are 
Wounded whether the Tendons have any Degree of 

Sensibility or not, at this Time I shall not Pretend
to Determine however I am of an Opinion that there 
are Nerves Passing into them, therefore they must have some 
Degree of Sensibility; from Injuries of those Parts You
will have a Tumefaction Come on, And in a Sanguineous
Habit Your Patient will sometimes be Delirious.
This Case highly Requires Evacuations and the 
Pulse will be your best Guide; in the Erisepellatous
Appearances Carefully Attending to the Pulse; If
You make too free wth. Evacuations, and bring the
Pulse below Part, will most assuredly You will
Destroy Your Patient, and You will never have it
in Your Power again to Raise it. I have been Eye
Eye Witness of the many Fatal Consequences Arising
from the ill Treatment of the Disease. There is no 
Disease so liable as this to Translation. An
Inflammation on the Pericranium will Cause it
to be Considerably on the Stretch, it behoves
You here to Divide about two Inches Down to 
the Bone, in the Wounds of the Scalp Fomentation
and Cataplasms, will when there is Inflammation
sometimes Relieve When by an Injury done to 

the Integuments of the Head. The Dura Mater by
Inflamtion becomes Separated; from the Internal Surface
of the Cranium. The Indicating Symptoms of such
Injury as Stupor seldom before the 2, 3 or 5 Day
or even 25 Days from Inflamation and Suppuration
takes Place and the Patients rigors becomes
Exasperated, And in this Case nothing but a 
Perforation will doe, Contusions of the scalp must 
be heal'd by the Discutients; And in all Cases
where there is an Extravasation, be very Cautious
in Prognosticating for it will Appear on the 
touch as if there was a Fracture wth. a Depression
but on the Application of Discutient Remedies
the Disease will frequently Disappear.... 

Lecture 8th.
On Injuries of the Dura Mater.
This Disease was well thrown to Hippocrates who has 
particularly heated of it. I mean to treat of this by 
Mentioning the Injuries, that liable to happen to the 
Dura Mater, from any external Violence on the Integuments
which are always to be Seen in those People who
Die Apoplectic or are Hanged, those Prints which are
then Visible are the Extremities of Lacerated Vessels,
The Dura Mater Serves the same Purpose on the internal
Part of Cranium, and is as Closely attach'd as the 
Pericranium is on the External; If You Perforate
the Cranium of those who Die Apoplectic, You 
will find it difficult to Seperate the Bone from the 
Dura Mater, when from a Fall or Blow a mature
Extravastion shoud happen You will find the 
Extravastion Verge in its Hand and Situation
it sometimes is between the Scull and Dura Mater
at other Times between the Scull and Pericranium
Whenever Situat'd the Symptoms are of Various
Kinds from the most Slight Swooning Down to the most
Comatose State sometimes a Loss of Voluntary
Motion, Hemorrhages from the Nose and Ears 

likewise happen. It sometimes so happens
that the Vessels are so Injur'd as to Cut off all 
Communication between the external Vessels and 
Internal Vessels, Consequently the Circulation must
be Imped'd wherever the Injury is. The Consequence
must be Inflamation and the Vessels put on 
a Sloughy Appearance, Extravasation is 
Caus'd by Detachment of the Vessels, the 
Inflamation then next, Comes on, And the 
Sloughy Appearance Follows, and the Separation
Cast off all, and it Looses its adhesion this
is the Consequence of the Inflamation, You
ought to be well acquaint'd wth. the Manner of 
Distinguishing this Disease, Extravasation is 
Produc'd immediately, and is Symptoms of 
Depression simply, Inflamation is a gradual
Symptom and must be Prevented by Art, When
it happens in the Internal Cavity of the Cranium,
You cannot Know it by the Touch, when externally
you may Distinguish it, When Inflamation
Comes and Matter is Form'd, the Dura Mater begins
to Separate itself from the Cranium; the Pericranium
likewise becomes Separated on the external Surface
there is to be found a Bloody Kind of Tonics

between the Bone and Pericranium, there is also
a Puffiness and a Circumscrib'd Tumour on the external
Part to be found. If in Ten or Fifteen Days Your Patient
should have Loss of sight and other Symptoms. If 
upon Opening the Tumour You a Quantity of Same's
and the Surface of the Bone Put on a Dry appearance.
If Bloody You may take it for Granted, and 
Rest well Satisfied there is Mischeiff underneath
the Cranium We shall Divide the Circumstances
Attending these Accidents, into those Distinct Parts,
The first is (Viz) it very often happens the Blow
shall be such as to have any external Appearance
of Injury, The Patient now has Febrile Symptoms
Come on, Symptoms of Tightness as if a Chord
was bound part, round the Head, has Shiverings
Delirium and Spasms becomes Paralytic and Dies,
this Arises from an Injury between the internal
Surface of Skull and Dura Mater, this Case admits
of no Cure but by a Perforation to Let out the 
Matter, when the Extravasation is externally it 
behaves You to Open the Tumour, and Let 
out the Matter, and now We Consider the Injury
as Attend'd by a Wound, the Blow Given shall
Cause a Seperation of the Scalp, and sometimes
Communicate a Shock to the Vessels, You shall 

Digest the Wound and it shall Put on a favourable [Appeara???]
Appearance, but at the space of a certain Time
he Looses his Appetite, and the Symptoms
happen such as Fever &c; the Wound then immediately
Changes its appearances, the Pericranium will
Seperate for a a Distance round, And You may 
be well assured the Dura Mater is seperated also
and mischeiff is is Forming within the Cranium
the 3d. State is when a Blow is Inflicted in such 
a Manner as to Lay the Bone Bare, which is 
sometimes done by the Surgeon, in this Case You
have not that Guide as you had in the former
Case to goes by, but when the Dura Mater is Injured
You will have the Edges of the Wound all round
the Surface separated, the Bone will Look Dry
and Yellow, when such an Alteration has this 
happens be Attentive to the Symptoms. In all
these Diseas's the greatest Chance is taking it early
by Bleeding frequently, You will have Inflamation
Suppuration Delirium and Spasms, When such
Symptoms happen as Lead You to Judge there
is Mischeiff internally; You must not Wait
but when the Circumscrib'd Tumour wth. its Usual
Puffiness and Detachment happens You shoud then

Perforate the Bone, for if You Wait the Rigors/ the 
usual Attendant on this Disease will Come on, You will
by no Means Give Your Patient a Chance that he would
have had, if You had Perforated the Bone sooner
this is a a Matter of Serious Consideration also to be
Careful that the Disease Exists. If You doe it in
the early State, One Perforation may perhaps doe in 
the middle sometimes two or more are Necessary....

Lecture 9th.
Fracture of the Cranium.
Fractures of the Cranium may be Divid'd into two
Species the first in simple when the Bone remains
even; the Second when there is a Treatment wth. Depression
The Symptoms are Said to be frequent Vomiting a Stupor
and Loss of Blood, from the Nose and Ears, but remember
You are by no means to Rely on those Symptoms
for they may happen Independant of Fracture, and 
when they doe happen they doe not Arise from the 
Solutio Continui of the Bone, they Arise from the 
Concussion of the Brain, or from Extravasation
Seat'd in the internal or external Part of the Cranium
As my Intentions are to Set You Right, I can not
Help repeating what I have already Observ'd, in 
the Preceeding Lectur's without You recollect what 
I have Mentioned. You will be Yourselves at a great
Loss in My Following on's. In the Common Method
of Heaing the Fractured Cranium it is right 
to Perforate the Bone, and there be no Solutio
Continui As other, Purposes are Saved thereby
there are those Causes for Perforation two of which 
are Matters of Necessity; the Head is a Matter of Elation

or Choice, and this is Call'd the Preventitive Kind
of Remedy, the two former from the Consequence of 
Necessity, As when You have Reason to Suppose there 
is a Fluid seat'd in the internall Part of the Skull
it then becomes a Matter of Necessity, the Symptoms
are Caus'd by Violence done to the Vessels or Membranes
and by Fracture, the Performing the Operation
by Way of a Preventitive has Caus'd great Disputes
among Writers, there has been some few Instances
where Fractures have done well without Perforating
but this seldom happens, that was You to Compare
them you would not find an equal Proporation, between
those when it has been Perform'd, and those to
whom it was not, but sure no Man would goe to
Perform an Operation without an Absolute Necessity
The Consequence Arising in the early State from 
Fracture a Extra Inflamation, and in the latter
Suppuration, and if You Compare the Number
of those which Survive when the operation is 
Performed in the former State wth. those who
Perish in the Latter You will find an amazing
Difference, I doe this to this to Show You the 
Absolute Necessity there is in Perforating the Bone
Considering the Number in both Hands, to these 
Cases I shall, add another; In Case of Extravasation
You have Indicating Symptoms and if You

defer it until the Latter, that is when Inflamation and 
Suppuration Come on; I say when this happens You
will find it frequently fail, and the Patient do's not 
Stand that Chance he did; had You made Use of 
the Preventitive Method; And when You doe Perform
the Operation it is not in Consequence of the Bone
being Broken, but from the Alarming Symptoms
wch. happen to the Soft Parts from Injury being
done to them; the next Consideration is the 
Objections our forefathers had, the one Reason
was the Air having Access to the Internal Parts,
besides this their Instrument where exceeding
Clumsy are often times to Injure the Membranes
and this render'd them Fearful of Performing the 
Operation; Its very, Strange the fear of Injuring 
the Dura Mater shoud then Deter them, When
their Writings Mention the Dura Mater was not 
Adherent. Mr Patt Says the Ills Arising from the 
Perforation in every Way Consider'd by no means
equal to the Fracture be it smaller larger.
I shall first Mention 2 or 3 Circumstances where 
the Operation may become necessary. If the Bone
be Broke and there should not be any appearance 

of external Violence, You will Consider it as a Contusion
will Bleed and Purge the Patient, and at the end of a 
certain Time as 4 5 or 2 5 Days. Febrile wth. other Symptoms
which will Reduce you to Examin. If You find any 
Tumefaction You will Open it, You then most 
likely will find underneath the Tumour a Quantity
of Sanies, and a Fracture; No Man a Live could
Hesitate a Moment to Perform the Operation,
You will find the Dura Mater Detach'd and more 
or less Matter Form'd, and You Let it out 
immediately and by that Means You'll Give
Your Patient Relieff. You doe not Perform
the Operation because of the Fracture, If the 
Fracture remains then no Harm can Arise from 
that. If Considering it in another Light it 
happens at the Time of the Accident. There is 
a Lacerated Wound of the Scalp; You will Drop it
after the Manner of any other Wound Inflicted
on any other Part of the Body, And at the 
End of a certain Time, the Wound will Change
its Colour and Appearance, and the Pericranium

for a certain Space round, will be Detached
the Perforation, is Now Necessary to Let it out what
was the Cause of the Disease, there is but now 
one Reason why you should Perforate on the 
Fracture and that is where there is a Fracture wth.
Depression, You then are to Perforate in such a 
Manner as for to [illegible]  You to Raise the
Depressed Portion.----

Lecture 10th.
On the Application of the Trephine.
Perforating the Skull becomes Necessary from the 
Extravasation of Blood, or Lymph. I am Now to 
Describe to You the Manner of Performing this 
Operation by Removing a Portion of the Bone,
to Prevent or Remove the Injury Arising from 
the Blow Receiv'd. An Observation Our
Forefathers made was that on Examining.
The Dura Mater immediately a Streak of Blood
was found on its Surface after a Fracture
that in Consequence of this they had [illegible]
to Enlarging the Fracture imagining the Sanies
Decpt from the Edges of the Fractured Bone and they 
through fear seldom Performed this Operation.
Whoever Varios the Instruments they made
Use of will not Wonder at their Fearfulness
One Error amongst the Rest was their Manner
of Applying their Instruments to which was 
Usualy to one side of the Fracture, His Call'd
the hepan and it is a very bad Constructed

Instrument and the operator Labours under a great 
many Difficulties, and Inconveniences, but its
certainly an Improvement, the Instrument Now the 
of is Call'd a Trephine, and is much better
Constructed than than other. The Skull is Perforated
to Prevent or Remedy any Evil Arising from
Injury done to the inner Parts, from the Blow
Receiv'd by Perforating, Your Intention is to 
Remove such Injury. When You are going
to Perforate the Bone, You are if possible, to fire
Your Instrument in such a Manner as to Include
both Edges of the Fracture, the larger Your Trephine
the better and which I would always Recommend
to Your Use, When You have Perforated a small
Way into the Skull, You are to Remove Your
Instrument from Time to Time, and thus going 
on gradually and wth. Caution, the Operation
is Capable of being Performed wth. Safety.
But one Perforation will not doe, If You 
find a Deluge of Matter, and the Dura Mater
a Considerable Way round Detach'd You will 
be Obliged to make a Second Perforation 

in Order to give an opening to the Matter there 
Secret'd and sometimes a third will also become
Necessary, You had almost better to Let a Part Perish
than to make an Idle and insufficient Attempt; I 
Recommend to You if possible to Remove the 
whole Fracture, it sometimes happens after
some Days after the Operation Your Patient will
have Febrile Symptoms Come on; And other 
Appearances which will Render You able to Judge,
that there is a Lodgement of Matter, You are then
Necessitated to a Fourth Perforation. In a simple
Fracture You have not so good a Guide in the 
beginning as in a Fracture Attend'd wth. a Depression.
In that Case the symptoms are such as Lead You 
to Judge, from the Pressure made on the Organs
of Sensation and Motion, You are then to Perforate
on the side in Order to Elevate such Bone, therefore
the Instrument is applied different in this Fracture
from the simple in Situation in Situation I would
always Remove a great Part of the Depressed
Bone, and not Content Myself wth. merely Elevating 
the Bone. If You doe it is more than two to one 
that Your Patient will Perish, You shoud if those 

is a Hazard of the Bone [illegible] get a proper Assist
to Elevate the Bone, which You Perforate. In the 
simple Fracture You have one Object to Remove (viz)
the Cause but in that wth. Depression You have two
the Cause and the Depressd Bone; there has been
much said about the Dressings and Bandag's 
after the Operation, all Kind of Initiating and 
Depressing Applications should be Avoid'd, I Know 
of none better than soft Dry Lint, You can not 
Apply Your Dressings too Light for this Reason
I would Advise [illegible] other Bandag's than
merely to Retain the Dressings, for this 
Purpose a Common Yarn Night Cap, which is 
Capable of being Dilated and makes an equal
Pressure, the different Bandag's delineated
in Books are very Prejudicial.---- 

Lecture 11th.
On Extravasation, and Concussion of the 
Brain, and Caries of the Cranuim
In the Fourth and Fifth of the Reading Lectur's, I have 
Endeavour'd to Point out the Prognostic's Appearances and 
Method of Treating all Cases Arising from Extravasation
Extravasation of Fluid, And Commotion of the Brain, in 
Two very Distinct and different Causes, they may 
Arise from wth. or wth.out a Fracture; Extravasation
from what Cause sooner it may Arise is different in its 
Appearance, it may either be in a Fluid or in a 
Coagulated Form, or as I have seen it a mere 
Lymph, or Lymph mixed wth. Blood, it is likewise
as differently Situated; sometimes between the 
Skull and Dura Mater, and at other Times between
the Dura and the Pia Mater, and sometimes in the 
Ventricl's, it may either be in smaller or in a 
larger Quantity, upon this Depends in a great 
Measure the sooner or Later Appearances of the 
Disease, and from its different Seat so will You
have greater or less Hazard, when it is situat'd 

the Skull and the Dura Mater, it is not so
hazardous, as when Situat'd between that and 
the Pia Mater, and still greater when its Situat'd
between the Ventricl's, one Unhappy Difficulty
We all Labour under, in Extravasations, they have
different Kinds of Symptoms tho we may always
Judge of Pressure by the Patient Loss of sight
and Voluntary Motion, Yet We cannot be certain
of the Seat of the Extravasation, yet in that Instance
where there is a Depression of the Bone, We have is 
sometime in our Power to Cause an Absorption of 
the Extravasation, I have Seen Cases where the 
Extravasation has happen'd in the Venticl's, and 
the Symptoms Come on Gradatim, Which
Plainly Shews the Lymph is to be Shed gradually
what Kind so ever the Extravasation, either of Blood
Lymph or Coagulum, there are but two Methods
Proposed for their Treatment the one is to Cause
a free Evacuation, and the other by Perforation,
at the Time the Blow being Receiv'd, If You
have a Contus'd or Lacerated Wound, You have then
some Sort of an Authority where to Lay Your
Trephine, When You have not such sort of Apperances
You must Perforate in such a Manner, as Appear 

The most likely to Remove the Blood or Lymph
Your Dressings must likewise Coincide wth. Your
Intentions, all those which Cause Irritation must be  
Avoid'd; It vary often happens after You have Perforated
the Skull You will find the Dura Mater of a Silver
Colour, at others of a quite different appearance; No Blood
or Lymph is to be Seen, on the Surface of the Dura 
Mater, and it is Elevated where the Perforation ever made
made, it is a Doctrine recommend'd by some Writers
to Divide the Dura Mater but unless there is Blood
to be formd, and there shall be appearances, such
as Change of Colour on the Dura Mater, and such 
other Symptoms as Lead You to a Necessity of 
Making such a Division, I by no Means Advise
You to Divide the Membrane, but where You have
these Preceeding Symptoms Attend'd wth. an Elevation
of the Scalp, You will there have Mischeiff underneath,
and you must then Divide it; If at the Time of the 
Accident a Piece of Depressed Bone or any
Foreign Body shoud Lacerate the Dura Mater
ill Effect will then Arise, so likewise from 
Lancet or Bristory, tho I dont regard the Perforation
I seriously Advise the Division of the Dura 
Mater, I was sent for to a Boy a few months ago to 

belonging to Christ Hospital, when I soon found
a Fracture Occasioned by a Part of a Scaffold falling
upon his Head. I trepan'd him and from appearances
Judg'd of Necessity to Divide the Dura Mater, by 
which Means a Quantity of Coagulum was Discharged
and the Boy was Instantly Releiv'd, and Remains
now in Perfect Health. A Concussion of the 
Brain has been spoken of in a general Manner
but it is a distinct Disease, and should only
be Consider'd in a single abstract Manner.
By a Commotion I mean such a shock as has
been Given to the Medullary Part of the Brain,
as happens to both Cases from Persons being
Knock'd Down, they have a Swooning this Arises 
from Commotion and is not the Effect of Pressure
As I have seen several Instances from a fall
a Person shall Receive an External Injury upon
the Head, but having when falling been in such 
a Position as when sitting has Given such
a Shock to the Brain, that has been follow'd by 
such Symptoms as that Death, has often
been the Consequence, the Patient becomes
Irrational, frequent Bleedings wth. Opening
Medicines should be made Use of 

for the Operation, all You can do is to Procure
Evacuations wth. regards to Wounds Inflicted on the 
Meninges they should be treated, in such a Manner
as will best tend to Prevent Inflamation; It remains
now to Tell You the Certain Place for Performing
the Operation, You are Justly Forbid to Perforate the 
Skull on the lower Part of the Os Frontis; On Account
of the Frontal Sinuses's, Another Part in which We
are forbid by Writers is the Posterior Part of the 
Os. Occipitis, the Os Temporum, is another Part to
hear of Dividing the Temporal Muscle, but those 
Writers Consider'd not that it was impossible to 
Perforate the greatest Part of the Parietal Bone,
without the Previous Division of that Muscle and 
its Tendon, Another Cause of Fear was the Division
of the Artery, the Locked Jaw is a Local Disease
and do's not Arise as some Imagine from a Division
of that Muscle, Our Forefathers forbid the 
Perforation on the Sutures, Supposing the 
Hemorrhage would be so great as to Prove 
Dangerous; I by no means Recommend the 
Perforating the Sutures where You can Avoid it.
I doe not Mention it as I would have You
Guilty of Rashness, but to Show You the 

Longitudinal as any other Sinus may be 
Punctured, without that Danger or Ill Consequence
Arising from it, I once Purposely open'd the 
Longitudinal Sinus of a Woman I hapen'd which 
instead of Producing any ill Effect rather Gave
Releiff. A Caries of the Cranium sometimes
happens and is Produc'd from Two Causes, the 
one is from External Violence, and the other is from
the Lues Veneras About ten Years ago an Elderly
Man was Riding in his Coach, was by a sudden
Joilt thrown from his Seat, and Struck his Head
against an Iron which was fasten'd at the top of 
the Coach, he felt at that Instant an Acute Pain 
but it soon Went off. Sometime after I saw him,
and found his Head in an Erisepellatous State
there was a small Wound, and upon Examining 
I found the Bone rough; and to my great
Surprize Reced'd from My Fingers, which 
immediately Gave him immense Pain, I Remov'd the 
Carious Part and then soon became Well. In a Venereal
Cause they likewise become Carious when the Disease
when the Disease in the soft Parts. A Mercurial
Process is Useful, but the Moment it Cease to but

as a Medicine it becomes a Poison. I have been an Eye
Witness to this in Numberless Cases, when the hard
Parts are Attach'd You must have a suppuration, and this 
is only to be Effect'd by a Nourishing Diet, and where 
it may be proper to make use of the Hard Recruit.--

Lecture 12th.
On the Fistula Lacrymalis.
The Subject of this Lecture is Commonly, tho
improperly Call'd the Fistula Lacrymalis, there
is no Disease wth. which the Human Body is Affect'd
has Caused a more Variety of different Opinions
amongst Writers than this has done; the Ancients
where very Erroneous in their Method of treatment,
their first great Cause of Error is their having 
mistaken one Part for another, they likewise
being Unacquainted wth. the Part where the 
Lacrymal Fluid was Secret'd; you will find both 
amongst Ancient and Modern Writers a Variety
of Opinions about the Seat or Lodgement
of this Fluid, their Descriptions are Inaccurate
they where of an Opinion that the Caruncle
became and In Cyst'd Tumour, but they all
Agree in this Point that of an Induration
and Caries of the Bone according to their 
different Opinions, so likewise they differ in their   

Manner of Treatment, they who Imagin'd the Diffusion
more from Inflamation and endeavor'd to suppurate
the Carunculi others by making an Incision to the 
Carunculi in Order to Eradicate it, and others
made Use of Ecsharotic Applications, Whoever
Treats it in this Manner can never succeed in his 
Intention, by Irritation it is Certain You encrease
the Disease, Vision could not be Perform'd
wth. that Facility it now is unless the Surface of 
the Coats where Kept Continually Moist, and free
from Dust or from any Irritating Body, the 
Lacrymal Glands Serve for keeping the Tunicæ
Cornea Moist, and bright and to Remove
any Dust from this Coat, when by Accident
they are Stimulated either by the Passions
of the Mind, or by any Extraneous Bodies, the 
Lacrymal Fluid becomes so much increased, as 
to Run down the Cheeks, it is then Call'd the 
Tears, when the Disease Exists, it is sometimes
so Avid as to Occasion Excoriation, of the Skin
the Quantity of Fluid is not Known, the 
Lacrymal Sac is Situat'd in the Ductus Nasalis

which Opens into the Nose, behind the Os Spongiosa
Inferiora, the inner surface of this Duct is Besmeared
wth a Fluid to Prevent any Irritation. The Fluid
Devis'd from the Lacrymal Gland is Facilitated
by the Motion of its Lids, is Receiv'd by the 
two Puncta Lacrymalis and then Convey'd into
the Sac, those who Labour under this Disease
from what Cause so ever it may Arise have this 
Sac Obstruct'd, the Consequence of this is the 
Tears run Down the Cheeks, this Disease as 
its Origin from a Variety of Causes. In the 
beginning from improper Treatment sometimes
after the small, Rose, or from the Mucus Membrane
which the Lacrymal Sac being Obstruct'd.
The Moderns Say that this Disease in its
first State Arises from a Lodgement of the 
Lacrymal Fluid, all Obstructions of the Fluids
when Lodged become very Hurtful. Its Colour
Depends on the longer or shorter Existance of the 
Disease, so do's the Colour Change. It has been 
Improperly Calld Pus, as I Mentioned before,
It Arises from a Variety of Circumsances and 
is Attend'd wth. such as Form Obstruction in the 

Nasal Duct, If by ill Treatment the Bones should
become Carious, as sometimes happens from the 
Pore Polypus or Cancer, so according to the Disease
and other Circumstances, You are in a great Measure
to be Guid'd, in the Manner of Treatment, or other Means
You are Oblig'd to make an Opening for the Discharge
of the Fluids, some of the French make Use of a Syringe
to Inject the Sac. If it will Pass from the Lacrymal
Sac into the Nose it may doe, but whoever will
View the Syringe and Probe they make Use of will
See the Impractability of the Operation, Compress and 
Bandage have sometimes been made Use of wth. Success, but 
then this Pressure must be in such a Manner upon the 
Bay as will Remove the Obstruction, and avoid
giving Irritation, I have tryed that Invention of Mr Sharp's
but is Proves Ineffectual, You will find in the 
memoirs of the Royal Academy at Paris, a Variety
of Methods for to Remove the Disease, there Two 
Methods now Observ'd, the one I think very Rational
the other rational Method I recommend to You 
is this, by making an Incision into the Duct and Passing
the Knife in such a Manner as not to Injure the 
other Parts, having made Your Incision, You are then 

to Apply Lint, in such a Manner as to Preserve
Your Opening, and then gradually Dilate it by a 
Piece of Spunge or Bougie, or a Piece of Lead,
which must be Introduc'd to Pass the Nasal Duct
and thereby gradually Dilating the Opening, a Cure
will be Effect'd; the Tent must remain in Three
or Four Months least the Disease should be Renewed
the Scar by these Means will become very simple
this Disease is often very difficult to Cure, but its often
Owing to their going on Dilating and Causing
Inflamation, which ought always to be particularly
Avoid'd, all Kinds of Bandages or Pressing Bodi's 
are Prejudicial; I am now to Inform You of the 
best Method of making a New Channel, when either
by this Treatment or any other Cause it is so Obstruct'd
and not to be Remov'd. The Ancients made Use 
of the Caustic and Terebra, when we doe it We only
Mean to Perforate into the Nose, the most frequent
Method for this Purpose till Lately was the Cautery;
Mr Chapaldon Stands first for the Inventing and 
making Use of this for the Removal of this Diseae;
I have Seen many Disagreable Effects Arising from it 

for in Spite of all Your Efforts to the Contrary You will
Destroy the Neighbouring Parts, which most Certainly
You ought to Avoid doing; For the Purpose of 
making this Opening, there is a much better
Contrived Instrument, the Curv'd Trocar, when You 
have made Your Perforation, which You will Know
by Blood Passing through the Nose, then Apply
Your Tent of Lint, and then some Drawn Lead to 
Maintain the Opening taking Care to Avoid
giving Cause to Inflamation, and lastly not 
to Remove Your Tent till the Time above Mentioned. 

Lecture 13th.
On the Cataract.
The Eye Consists of Three Coats, tho there are 
some who have made five. It has likewise the 
Humours. The Tunica Sclerotica, the Tunica Cornea
which is Transparent, and the Tunica Retina, wn.
The Tunica Ubia and Iris; the Humours are the 
Aqueous which is the Anterior, the Chrystalline
and Vitreous, which are situated Posteriorly,
the Diseas's of which I am now to Speak have been
much Misrepresented, by Writers, it has been Supposed
as Consisting of a Variety of Circumstances, it has 
however one Plain Disease, It is an Opacity
of the Chrystalline Lens by Vision is Variously
Imped'd or wholy, Destroy'd, it Varies in its 
Appeance and Colour (Viz) of the Pearl Blue
Brown &c, the general Doctrine in regard to this 
has been that at first when the Disease has made 
a small Progress, it was then Immature; but as 
the Disease increased it then became Mature 

and fit for the Operation. That this Doctrine is not 
always true is very Certain, I have several Times seen where 
from a Blow being Receiv'd, the Chrystalline Lens becomes
immediately Opake; Again I have seen where the 
Cataract her remain'd in a Fluid State all the Time
The Disease has Exist'd, therefore the Shortness of 
the Time making it Mature or Immature, is Uncertain
I have seen the Chrystalline of a Living Animal as 
Capable of Resisting as in the Dead Body, the 
Dissolving of the Chrystalline Humour is Proceeded
by a Pain of the Head, in those that appear
While and Indurate is sometimes the Effect of 
Age, there are some Circumstances which Determine
the Event of the Cure. If the Patient and 
Opake Chrystalline can Perceive the Light there
is scare Hopes of Success, but if the Patient
cannot Discern the Light there is a little more.
Besides the Dissolved and Indurated Cataract
there is Another which has been Term'd the sheting 
Cataract, another Circumstances which shoud be 
Consider'd is the Mobility of the Papillae, which 
if immovable is very Favourable, but if not the 
Operation should not be Attempted, If You Look 
into Books You will find a Variety of different 

Methods for Performing the Operation, the Disease
in its Cure is simply, there are two Methods of 
Operating now in Use, one by Depression of the 
Chrystalline Lens which is the Oldest Method, the 
other is by 3 Extraction; the Latter took its Rise
from Accident as many other Improvements
in Surgery have done, to Extract the Chrystalline
Lens You make a Transverse Incision on the 
Cornea a taking Care not to Injure the Eyes when 
its Coats Unite, by this Means You will Preserve
the other Humours from falling out, in Order to 
Depress the Chrystalline Lens, You Pass
Your Needle in the same Manner, but Pass Your
needle into the Posterior Chamber of the 
Aqueous Humour, You are then to Turn Your
needle breaking Down the Cataract, and when the 
Papilla becomes Clear, You are to Depress it,
sometimes it will rise again on the Patients
Stooping Down, and again Sink Down on the 
Patient being Erect, sometimes it happens that 
the Division of the Cornea will not Unite, and 
a Quantity of Humour will fall out, the Light
still remains, the best Method I think is that 

by Depression, as You have not so many
Inconveniences Attending it as by that of Extraction
after the Operation a Plaister of Soap Cerate shoud be 
Applied and the Antiphlogistic Regimen follow'd
frequent Bleedings to Prevent Inflamation, and 
if necessary opiates should be Administer'd. 

Lecture 14th.
On the Polypus and Hair Lip
The Polypus Narium is a Disease concerning which both
Ancient and Modern Writers have given very 
different Accounts, wth. regard to the Manner of 
Treatment, but that it was one distinct Disease,
It has however very different Appearances, and 
is Attach'd to different Places, sometimes from 
the Septum Narium, or from the Pituitary
Membrane, sometimes from the Os Spongiesa
or Hanging from a stalk. It is sometimes
Indolent and at other Times Not, and the Bone
to which it is attach'd will sometimes become
Carious, whoever fills himself up wth. Hopes, that
a Polypus will be easily Cured, will find himself
much Deceiv'd. the Cheiff of the Ancient Writers
seem to have been at great Pains, to find out 
some Remedy to stop the Hemorrhage which
they Imagin'd happen'd after every Polypus
was Extracted, and this seems their Grand Object 

in View, but Venture to Lay that those Kind
of Polypus wch. admit of Extraction and are Curable, that 
from these no Hemorrhage will ever Ensue, wch. will Require
Assistance to Stop, I never Saw but one Kind of Polypus
which would Admit of Extraction, or being Cured, More
Kinds of Polypi that are not moveable and are
not differently Affect'd by different Kinds of Weather
and that Put on a Cancerous Appearance, had much
better be Let alone for by Attempting this You
will not Succeed, that Kind of a Polypus, that may 
Admit of a Cure is that which is Movable in Respiration
When the Patient has no Cold it Appears as if 
filld wth. Colour'd, Lymph, and that on taking
Cold becomes troublesome, and in rainy Weather
becomes Enlongated and enlarg'd. If Frosty becomes
less and Contract'd, and on Pressing it a little
Fluid Drops from it, those Polypi which doe
not Answer this Description, will not Admit of 
the Operation; Escharotics which have been made
Use of in this Disease Serve only in My Opinion
to encrease it, some have made Use of Ligatures
but it is difficult to Pass them high enough to the 
Rest, without that You doe not remove the 
Disease; the Polypus is generally Attached to 

the Os Spongiosa; the Method of Extracting
the Polypus is to Pass it up to as near the Root
as possible, a Pair of Forceps wth. Holes in and 
Fall down in a Reight Direction, and not by
Forks, and Hoisting the Forceps and You will
Detach it, It sometimes happens a small Portion
of Bone will Come away wth. it, but to this 
You will Pay little Regard. Those Writers
who Say a Polypus will Grow again, from 
the same Place where the other was Detach'd
have Wrong Ideas. Those which are so much
enlarged as for to Hang Down, and appear
in Sight, either without the Nostril or behind
the Velum Pendulum Palati, are all distinct
Polypi, and that after the Removal, of one error
You shall have another in a short Space.
It has it Attachment at another Part, and 
will Come Down in Consequence of the other 
being Remov'd. 

The Hair Lips
The Hair Lip is of Four Kinds, two of which are Confin'd
to the Lip only, the third is attend'd wh. a Division of the 
Manilla Superior. The Fourth is Attend'd wth. an Horizontal
Protrusion of the Denticular Ridge of the same 
Bone in the first which is only a Simple Division
of the Lip You are to make an Incision on each 
Side so as to Remove the Callous Edges, and Procure
a Speedy Reunion Some have been of an Opinion
that when this Discovers itself at Birth it is much
better to Put off the Operation for a Time, for these 
Reasons Children are apt to Cry, and are apt to 
Endeavour to Remove their Dressings, but these
are very Triffling Objections, for My own Part I never
Object to Performing the Operation, but rather 
prefer it at an early Age; After having Pared
of the the Edges, You are to Introduce Your
Pins and Suture which is the best Method, tho
I have seen the Common Interrupted Suture wth.
Sticking Plaisters doe very well In the Second
You will have two Separate Divisions Opposite
Incision You can not Heal both at the same Time, but
having Perform'd one and suffer'd it to Heal to and [illegible]
the other Under the Division of the Lip You will

sometimes have an Horizontal Protrusion of 
the Maxilla Superior which Comes under the 
Fourth Kind, this must first be Remov'd before You
Attempt the Cure in this Case the Dentes
Incisioi must be Soft, being Oblig'd to Remove
a Portion of the Alveoti sometimes there is a 
Division through the Maxilla; And in this Case
You will Expect to the Benefit; the Impediment
in Speech the Difficulty in Drinking must 
all be Submitted too all You can doe is to 
Unite the Soft Parts, and render the Deformity
less Obvious; The Pins now made Use of are now 
much Improv'd. There Points Screw off which 
Prevents many Inconveniences both to the 
Patient and to the Nurse, which before they 
where greatly liable to.....

Lecture 15th.
On Diseas's of the Trunk
and Thorax.
I shall Divid them into Two Heads, first those that 
happen within the Cavity; and 2d. those that happen
without the Cavity, there within are the Vomica 
Empyema and Hydrops Pestoris, those without are
Wounds and Fractures of the Ribs; Empyema
Cancerous and schirrous Breasts, Wounds on
the external Parts are Triffling, but You must Pay
Attention to Prevent, Inflamation, which is 
Liable to happen, from the Lungs in Respiration
Those Wounds which Penetrate the Cavity of 
the Thorax are Matter of Consequence, they should
be Dressed as Quick as possible, to Prevent the 
external Air, which besides Compressing the 
Lungs, and necessarily Preventing a free
Respiration, will likewise Impede the Circulation
of the Blood, and Stagnating it in the 

Right Auricle. Those Consequences will Arise from 
Wounds Perforating the Cavity of the thorax independent
of any Injury Communicated to the Lungs, and 
which the external Wound Appears largeness
sometimes Unhurt. tho in Perpetual Motion
free Respiration and the Impulse of Blood.
When any Injury was Communicated to the 
Lungs, the Ancients Pronounc'd it Fatal. But they 
are not always so. It Depends upon what Part
they are Wounded; At the lower Part they are 
not so Dangerous, the Ramification of the 
Artery are not so great as they are high up
But the Danger in a great Measure Depends
on the Size of the Wound it may be Raise'd high
up Yet the Patient may Recover. from any 
of the above Mentioned Causes, the Lungs may 
be either Compress'd, or Inflat'd so as to Prove Fatal
by the Blood, Stagnating in the Right Auricle
of the Heart, A Case that I saw a few Years
ago will Prove the none Fatality of a Wound of 

the Lungs; A Boy a Waiter at a Tavern running 
up Stairs hastily wth. some Knives in his Hand
Slip'd Down, the Knives also fell and one of them perpendicular
wth. the Handle of it in a Hole, which the Boy
fell upon, I was Sent for and found a large Wound 
on the Right Side, and from which when a 
Candle was Held to the Part, was immediately
extinguished by the Air returning out.
There was some Hemorrhage, but that Ceas'd to Flow 
of itself it was Drop'd Lightly and Speedily
and the Boy did well, not Attend'd wth. any 
bad Symptoms; there Accidentaly some of the 
Vericulae Airiae was Wound'd on the Surface of the 
Lungs, when the Wound was Exposed he was in 
great Danger then of suffocation; therefore Nature
Led him to Cover it wth. his Hands, which he 
was Obliged to especially in the Night, when by
Accident the Dressings where Unavoidably
Removed, Fractures of the Ribs are Painful
and Troublesome, the Method of Treating them 
is to Kind a Napkin round the Body, Oily 

Medicines, Opiates and the Antiphlogistic Regimen
shou'd be made Use of to Prevent Inflamation, but it
sometimes happens that of spicula of the Fracturd
Ribs will Press through the Pleura and Wound
the Lungs; the air then Rushing into the 
Cavity fills the Tela Cellolosa, when every Part
of the Body which has any Cellular Membrane
will be Distended also and Cause the Disease
Call'd Empyema, the Lungs will Perform
their Office wth. great difficulty and the 
Patient generally Dies of suffocation, and 
non Circulation; Puntures and free Incisions
are Said for to Cure the Labor, I prefer as it 
will give a more and greater Passage to the Air
You are then to make Use of Friction upon the 
Emphysematous Tumours, wth. Your Fingers
which are always to be Oiled to Prevent giving
Pain and Inflamation, Yet Notwithstanding all
this it is mostly Fatal. The Breasts of Women as
liable to many Diseas's; Abscesses are what 

I shall now speak of; they are very frequently
Caus'd by the suppression or Driving Back of the Milk
which Custom Rewards the Intention of Nature,
which is done to Avoid Trouble or Suckling of the 
the Child, or to Avoid Sporting the Shape of the 
Regular Form of the Breast. Woman should be 
Persuaded to Suckle their own Children, as the 
Mothers Milk Purges off the Meconium, and is 
much more Nourishing than that of Another Woman.
As that peculiar Quality which is in the first
and nearest Milk, is here Wanting in the Strangers
Breast; Render by this they will Prevent the Fever
very frequently occasioned by the Stoppage of the 
Milk, and likewise the Causes of Abscess and 
Indurations; these Kinds of Abscess Incident to 
Women, from the above Mentioned Cause have 
been generally ill heated. The Common Method
which hollow'd in the beginnig was to apply
Adhesive Plaisters over the Breast, and where 
a fluctuation was Perceived, there they Apply'd
Caustics, which Methods by Prudent Men 
are never Practised, some make Use of Means to 

Discuss or to make Absorption and a Suppuration
as we have it in our Power to Assist by either of these
Methods to forward Suppuration, You are to 
Attempt by gentle Evacuant, and Emollient
Poultices Continued till it Bursts, as it then
generally makes a more Depending Opening.
Caustics should never be Applied. If it should not 
Burst of itself, a Puncture will become Necessary
which should be made large enough to give free
Passage for the Matter, As by this Means You 
will be Prevented from making Another, Your
Business is to keep the Divid'd Lips of the 
Wound asunder, by this Means You will give
free Passage to the Matter, which is of the 
Utmost Consequence to Your Patient and to Your own
Character some have Imagined that the Matter
has Pointed in such a Manner, as You will not 
be Able to make a free Discharge, from the 
Nipples being in the Way, but they have been
Mistaken, for You may always Avoid
Wounding the Nipple.---- 

Lecture 16th.
On the Schirrous Breast.
Our Forefathers Gave the Name of Shirrous to all Tumours
that would not Admit of Disputation; The Moderns
Term those Schirrous which will not Admit of 
Suppuration and Bears an Affinity to a Cancer
sometimes only one Gland becomes Indurated at others
more and in some the whole Breast, It Appears
sometimes Indolent and not Painful to the Touch
in others it will not Bear the Touch without Giving
Pain. Whenev'r the Nipple is Retracted the 
Schirrous turns Cancerous, and is generally Fatal;
there are two Methods of Cure, the one by Destroying
it by Caustic, the other by Extirpating wth. the 
Knife; The Idea and Dread of Pain given by 
the Knife, has Induc'd many who Labour under
this Disease, to suffer Ignorant People Unacquainted
wth. the True principal of Surgery, to try those 
Pernicious Secrets which they too open Impose
on the Credulous People as Efficacious, they  

Attempted the Removal first be applying Plaisters
for that Purpose, when these fail'd which they 
always will doe, they Apply'd Caustic which 
are very Painful and Uncertain. Tho there is no 
Appearance of a suppuration, Yet the Diseas'd
Part will not be Clear'd from the Sound, the
Pain is greater than that of the Knife, and of 
longer standing. If You apply Your Caustic
too strong You may Injure the sound Parts,
If too Weak it will not Remove the Diseas'd Parts
and it will also by its Irritation encrease it 
and make it much Worse.
The Composition this Caustic generally Consists
of is Meadow Crowhoot Dog fennel Sulph
Vioum and Arsenick, made into a Paste wth.
the Yolk of an Egg, this is in their general Use
and Come from Stevens Hospital in Dublin,
this is their Boasted Secret, and which many
People are tortur'd wth. the Knife is the best 
Remedy if the Operator Knows how to Use
it, and is Acquainted wth. the Seat of the 

Disease, and Anatomy of the Parts, always
Remembering to have as much of the Sound Skin as
Possible. If the Schirrous Gland Lies deep so that there 
shall be some Cellular Membrane and Adipose
Situated between that and the Skin, you must 
make a Longitudinal Incision which will 
sufficiently enable You to Dissect out the Glands
at the same Time Preserve the Skin. The Cancer of the 
Breast has a Variety of Appearances and Appears
under a Variety of Forms, it is sometimes Painful
sometimes Movable, and immoveable, When 
Movable in a favourable Circumstance, it Indicates
there is a Cellular Membrane between it, and the 
Muscles of the Latter it is Unfavourable, and 
should not be Attempted, as the Cellular Membrane
is Indurated, and is Attach'd Firmly to the 
Ribs, a small Degree of Mobility should not 
Deter You from Performing the Operation,
Circumscription is another Circumstance which 
is when the Breast shall be Perfectly Movable
but the Parts of a few Inches round shall be  

Adhering, this also shou'd not be Removed as 
You most likely encrease the Disease
sometimes You will have the Milliary Glands
as large as Grains upon the Breast, this also
shou'd not be Removed, as you most likely
encrease the Disease, and bring on Additional
Pain. Whether the Breast be Ulcerated or not
it should be no Impediment against Your
Exterpating it; If the Pain be very Severe You
should Suspend the Removal of it, so also of 
the Glands in the Axilla or Neck be enlarged or 
Indurated, it is a certain Proof the Disease
Exists in the Habit. I have Mentioned a Variety
of Circumstances which are Prohibitions for 
Performing the Operation; the Prospect of Success
in Those Cancers which Arise from Internal
Injury are greater than those which does not 
as the Latter Indicates a Disease of the Habit.
A Cancer in the Scrotum Attend'd wth. Darting Pain
in the Back is Dissuasive, tho not always a 
Prohibition it sometimes being Local, 

A particular Circumstance to be Observ'd, is the Obstruction
of the Menstrual Discharge, which You should be Careful
to Perform before the Operation; On the other Hand if the 
Menses have Ceas'd to flow, their Bodies will undergoe
so many Changes, that You will have many Difficulties
to Encounter. The Present Method of Operating is this;
the most Painful Part of this Operation as in all 
others is in Dividing the Skin, which tho I am an 
Enemy to Calarity, shoud be done as Quick as 
Possible, You are to make two Semicircular Incisions
round the Breast into the Membrane Adiposa
Dividing Downwards to Dissect it from the Pectoral
Muscle, Leaving it as Bare as Possible, and 
taking Care to Remove all the Diseas'd Parts,
You will have but few Vessels to take up as the 
greatest will Retract themselv's; You shoud then 
Dress it Lightly wth. Dry Lint, and not to Remove
Your Dressings for at least four or Five Days being
Elaps'd, in short untill Suppuration is fully and 
Establish'd, as they will fall off themselv's, You will
then have a Clean Sore. But I am Sorry to Say 

after all Your Care, You will sometimes not 
Succeed, The Sore will have Promising Appearances
and shall Heal Kindly until about the Size 
of a Shilling when its Appearances will Alter,
it will become Glassy and will Spread, it will
Degenerate into a Phagedenic Ulcer and the Patient
will become Hectic and Die.---- 

Lecture 17th.
On the Hydrops Pectoris
The Disease may Arise from Two Causes, when the 
Body is Affected wth. a general Anasarca, and when it 
is Confind solely to the Cavity of the Thorax, the 
Hydrops thoracis is the same Kind of a Disease as 
the Ascites in the Abdomen, they both Arise from 
one and the same Cause, there is a Fluid Constantly
Transuded from the Pleura, which is Constantly
Absorbed; Whenever this Secretion becomes greater
than the Absorption, An Accumulation of the 
Fluid must certainly be the Consequence of it 
and which Causes the Disease; The Symptoms
of this Disease Laid Down by Writers are very 
Erroneous; the Disease may Exist and the 
Patient during Life may Suffer very little, and 
the Cause will not be known till an Opening after
Death. The Symptoms which Indicate the 
Disease are very great Depression and difficulty
in Respiration, especialy upon any encrease
of Exercise by the Lungs being Compress'd the 

Circulation will be Imped'd in some Measure
and the Blood is accumulated in the Right 
Auricle, in an Erect Position the Patient do's not 
Suffer so much, as when he Attempts to Raise
himself or Lay Down hastily, and again he 
becomes Easy by being Kept Quiet, these Observations
will Lead us to Distinguish it from other Diseas's 
when the Lungs are Diseas'd it may be Known 
by the Expectoration, which by this Means generally
Leaves the Patient; the Hydrops Pectoris is external 
to the Lungs, therefore Expectorants will not 
Releive, from the Extravasation of this Fluid,
which should Circulate through the Body;
The Secretion of Urine, becomes less in Quantity
but this is not Specifically in the Hydrops
Pectoris. Another Symptom is the Palpitation
of the Heart, from the irregular Motion of the 
Muscles, and is very Different from that 
Palpitation Arising from ye Spasms. The 
Intermission of the Pulse in this Disease is no 
Uncommon thing, nor is it Specifically Attendant
on it. It has been Apart'd by Writers that You may

Know the Disease, by the fulness of the Chest or on 
one Side, but I never was Able by any such
Appearance to Ascertain the Existence of any such
Disease; where there are certain Indication of this 
Disease, You should not neglect to Perform the 
Operation; a Variety of Methods have been Propos'd 
in Order to Perform this, such as the Introducing
the Trocar in the same Manner, as is done in the 
Ascites in the Abdomen. The Method Recommend
to Your Practise is to make an Incision about 
an Inch and a Half long through the Integuments
between the Sixth and Seventh Ribs Counting
upwards near their Angles doing it very Carefully
to Avoid Wounding the Intercostal Artery; You must
Direct Your Knife, near the Inferior Edge of the 
Superior Rib, You are not to Use the least Pressure
upon the Knife, but Use it wth. the same Caution
as when Performing the Operation for the
Prubonarale, You may then safely Divide the Pleura
the Vomica of the Lungs, this Disease is a Collection
of Matter in the internall Surface of the Lungs
Arising from Inflamation; The Cure of this Disease

is sometimes Effect'd, by the Matter being 
thrown up by the Trachea, tho sometimes it must 
Prove Fatal, by the Quantitey of Matter being so 
great as to Cause Suffocation; In a Collection
of Matter upon the external Surface of the Lungs
or in the Cavity of the Thorax, which some Writers
have Mention may be Known by Ocular Demonstration
have also Mentioned the same Method of Cure as in 
the Hydrops Pectoris.----

Lecture 18th.
On Vomica and Empyema
In all Internall Dises's of the Lungs amongst wch. the 
Vomica is Mentioned, Expectoration always is a 
Salutary Sign, when there is an Accumulation
of Fluid in the thorax, the Disease is Term'd Hydrops
Pectoris, and when the Lungs are Diseas'd Previous
to this Accumulation of Fluid the Symptoms
are different, to what they are when there is no 
Disease in the Lungs, they likewise differ when 
there is Adhesions these Circumstances You
shou'd Carefully Consider; There is another Disease
of the thorax, which generally is not Form'd
until after Death, We never Know when the 
Patient is Living. The Hydrops Pericard the 
Cause of this is the same as sometimes happens
between the Tunica Vaginalis and Body of the 
Testicle, and of the Disease already Mentioned
the Hydrops Pectoris, from too small a Quantity
of this Fluid Secret'd Adhesions take Place, the 
tumor I believe to be a Cause of Sudden Death, and 

in those who have a very Irregular Motion
of the Heart, the Lungs are Liable to many Diseas's
Inflamation Suppuration and Induration and 
frequently Subject to Adhesions, by Previous
Inflamation; the Lungs sometimes become
Suppurat'd; when the Matter is freely Expectorated
it is a Salutory Sign, in regard to that 
Matter which has made its Way through the 
Surface of the Lungs, so as to become Floating
in the thorax, Expectoration can be of no Service
and the only Way to Cure will be by making
an Opening to Discharge the Matter, after
the Method above Prepar'd, but there are no 
certain Symptoms which Indicate this Disease
Occasion'd by a Previous Adhesion of the 
Lungs to the Pleura, the general symptoms
of this Disease is Fever hard Pulse a Dry Cough
Parch'd Skin difficulty of the Breathing wth.
an Incapability of Lying on the Side not Diseas'd
without great Pain. By Means of Adhesion
a Fever Produc'd by so Necessary an Organ 

As the Lungs beine Prevent'd from Performing
an Office, so Necessary to Vitality. In Adhesions
of the Lungs, the Patient find Complains of a 
fixed Pain, so small that he can Cover it with 
his thumb and the Pain is encreased on the 
Patients taken in the Air. Adhesions is follow'd
by Irritation and Inflamation which
which is the Consequence of Suppuration, at this 
Time the external Parts become Load'd, and full and 
this fulness is Circumscrib'd which is the Seat
of the Matter. If the Lungs are Adherent partly
from the Inflamation and Pain; the Patient 
Avoids taking in Air freely; as the Disease encreases
the Matter will make its Way between the Ribs;
the Tumour will Appear somewhat Circumscrib'd
in its Figure it is hard in the Middle and Painful
farther from the Centre it is of the Œdematous
Kind, Joind wth. an Erysepellatous Appearance
as it Proceed. You will Perceive evidently
a Fluctuation, and being Satisfied there is 

Fluid Examine it no more, by this Means You will
Avoid giving Your Patient any Unnecessary Pain
and what is of still greater Consequences and 
happens from Pressure You will have the Tumour
Disappear, and the Matter will be Loose in the
thorax, and will be Attend'd wth. Fatal Consequences.
Your Business is always to forward Suppuration
by keeping the Skin Relax'd wth. Poultices.
There are some who Attempt to forward Suppuration
by Adhesive Plaisters, which only tend to Inflam.
and Irritate the Parts, And in My Opinion ought
to be Let alone, but I know of no Application to 
Assist Suppuration. Nature alone if Left to 
herself is generally sufficient where there is no 
Elevation of Parts, Evacuation wth. the 
Antiphlogistic Regimen becomes Necessary,
But when You have such Symptoms and 
Appearances as shew that Nature is Dispos'd
to Suppurate, You are then to Abstain from 

general Evacuations; when the Fluctuation of 
Matter is felt and the Skin Puts on an Inflammatory
Appearance, You are then wth. Your Lancett to make 
a Puncture, having done this You are to Introduce a 
Probe Pointed Bistory, and make an Opening sufficient
to Discharge the Matter, and then Carefully Attend
to the Habit of the Patient; You are to Apply some 
Lint to the Lips of the Wound to keep them from 
reuniting till the Matter is entirely Discharg'd,
this is sometimes so great as the Patient will
Sink under it. sometimes the Discharge will be 
Continued so long that it will be in Appearance like 
Sanies, it will be Requisite, You shoud apply
a Canula or Use some Means to Reserve the 
Wound Open, taking Care to Avoid all Applications
which Tend to Irritate and Inflame and Nature
will then Compleat her End.----- 







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