[Student’s Note-book of
lectures and cases] [??]
[written by T Tomlinson?]


[Th] [Barttret]
Lectures 
On the Venereal Disease
By 
Wm Osborne M.D.
Surgeon & Manmidwife to Stow Street Hospital
and
Surgeon to the first Regiment of Life Guards
1784




Lecture 1st
The Venereal Disease is at this period a very interesting
one, & has till very lately been a matter of great dispute.
whether a new disease or not. I myself am very confident
that the Disease is new: & am surprized how any man of 
penetration who clearly considers the Nature of it, can think 
otherwise, a Disease so different in Symptoms from any 
other? A Disease so connected with the manners morals & Philosophy
might convince any person that it is a new one, or else how 
could Horace & Juvenal have avoided taking notice of a Disease
so strongly marked as it is, it is a Disease that never existed 
formerly & commenced at that period of time when American
was first traversed by Europeans. It is well known in 
History that when the King of France first besieged Naples he 
returned Triumphant. & then the Disease was first known in 
France – In the year 1492 when  Columbus discover’d
America the Sailors first had this disease, & it was from them 
translated into France, & so rapid was its progress that in less
than half a Century it spread itself all over Europe
It is a matter as clear as that we exist, this Disease
was imported from America. Two Spanish Authors, [Cattonellus]
& Fallopius described this disease soon after its Commencement
the one called it the Morbus Novus, & the other Morbus
Incognitus. The Italians laid the origin of it to the French
& gave 


& gave it the name of Morbus Gallius, the French on the
contrary say, it first came from Italy, & called it Morbus Neapolitanus
there was formerly in London a disease somewhat similar to 
this, owing to the frequency of promiscuous Venery, & particularly 
at the time of menstruation and I’ve read of its being forbid in 
the time of Moses – In less than two years after the first
appearance of the Venereal Disease. Mercury was found to 
be a Specific for the Cure, but has often been in disrepute
from being administered by ignorant people, & the bad consequences
attending a misapplication of it 
We must however take up this disease from its first
commencement & divided it into two parts, The Gonorrhoea
Virulentia, or Clap, & the Leues Venerea or Pox. diseases
different from each other, the one local, the other general
& it has been disputed whether they are not different [Virus]
or matter. Dr. Duncan of Edinburgh has publish’d a
Pamphlet in which le tells us, they are diseases totally 
different from each other. for my own part I think it very 
possible for Dr. Duncan to have been deceived, & I think the
matter is beyond a doubt, that if the Gonorrhoeal poison is 
absorbed into the System it will certainly produce the
Lues Veneria
The Gonorrhoea (by which we mean the Gonorrhoea
Virulentia) is an inflammation arising from a poison 
which is 


[?]
which is capable of infection, & is owing to impure coition.
the time at which it makes its appearance is various in different
constitutions; it may in some be observed in 20 or 30 hours. & in 
other, it may be as many days without breaking out. A person
that has had an impure Coition, by hard drinking Violent [Exertion]
or any other irregularity may bring on the Disease which [otherwise]
might have laid dormant a long time. We will now describe the
Symptoms attending the Gonorrhoea Virulentia.
1st a redness at the orifice of the Urethra which is not always
noticed. 2nd a slight pain or uneasy titillation is found on 
making water as the urine passes over the Glans Penis, then
a little discolored discharge or running of a straw colour
sometimes if very virulent it will be green; these Symptoms
go on for a little time, but what was before a slight pain, now
becomes a smarting one, the discharge increases & the heat of the 
Urine is sometimes increased so as to produce the most
excruciating pain. We will now consider the seat of the 
disease; it never has far as I know [??eaches] to the bladder, yet 
is not confined to the Urethra alone, the structure of the Urethra
is a Villous membrane line internally by a number of small
[Launa] surrounded by the Corpus Cavernosum. The disease is
situated in the [Launa], Corpus Glands, Prostate Gland, Vescula
Seminalis etc. In Woman this disease is situated in the 
Prolabia Clitoris Meatus Urinarius & Vagina; Women from 
the situation & laxity of the parts, do not suffer so much as
the Men, as they have constantly a Secretion & discharge
which keeps the Vessels open 


The discharge in men is sometimes very great, & we may 
almost wonder where it comes from if the inflammation is
increased by irregularity, the Chordee, Phimosis, Paraphymosis
or any of these may take place, the Chordee is a 
very troublesome & Painful Symptom, & is sometimes so
Violent as to produce a discharge mixed with blood, when 
this happens there is a breach of substance & sometimes
an Ulcer forms The Symptoms are sometimes so violent
as to bring on painful swellings in the Groin, this however
is no proof of a constitutional Virus, for the disease may 
lodge there & very soon terminate these are the Symptoms
of a Gonorrhoea. There is likewise an other Symptom which 
sometimes happens, which is the Hernia Humoralis, this
is nothing more than an affection of the Testes & has 
no manner of communication with a Constitutional Virus.
it always happens from some excess or Intemperance & 
sometimes brings on a bad train of Symptoms, & the Virus
stops at the Epididymis, when this is the case the [??ning]
ceases immediately; it was the prevailing opinion that
the matter was absorbed (as is likewise another, which 
is, that it arose from Sympathy, but if this was the case
it would always happen) this change takes place in a 
few hours, & its process is too sudden to be the effects of a 
constitutional absorption


Absorption, the Cause, by some debauch etc. the Inflammation
is conveyed low down, & obstructs the Excretory ducts of the
Vesiculae Seminales; the Vas Deferens being inflamed, the
Hernia takes place & I am very well convinced that the 
Epididymis and Spermatic Cords are the seat of this disease
the case is this, Inflammations arising in Surfaces where
there is no Cuticle always bring on a discharge, whether in 
the Abdomen, Thorax, Eyes Urethra etc. it is all the same,
there is a fluid in all cavities of the body, which is Serum
or Water, possessing a small quantity of coagulable Lymph 
How this fluid escapes was a dispute betwixt Dr. Hunter
& [Wr] Hewson, we all know there is such a fluid, but it
is not coagulable Lymph or what that escapes in a
Gonorrhoea the Gonorrhoeal Virus has a power of fermentation
of a specific power of changing other fluids into the same
quality as itself, if a small particle of the Virulent Virus
adheres to the Ville of the Urethra, where it lodges, it acts as
a fermentative with the coagulable Lymph, & converts the
fluids into the same Virulent state hence the cause of
so great a discharge; the discharge of a Virulent Gonorrhoea 
does not arise from Ulcers or any breach of substance, I do 
not mean to say there are never ulcers in the Urethra, tho 
it Very seldom happens


All infectious diseases have a regular Process & Conclusion
Infectious diseases generally go on untill a certain period, but the
Gonorrhoeal poison may continue a long time, 20 months or
upwards  Nature makes use of the following methods to 
throw the disease off, [2] an Inflammation & [derivation] of blood
to the diseased parts to dilute the poison, because where there is
a large quantity of blood confined matter will form, except indeed
where there is not any Cuticle, & even there an exertion of the parts,
which occasions a greater secretion of the fluids, & this coming in
contact with the Poison creates fermentation, & consequently a
transfusion of matter, which carries the poison away; that this
is the state of the parts is well known, for, upon examining a 
Gonorrhoea after death, we observe nothing but an increased 
redness & moisture so that the Idea of Ulceration must be false.
After the Inflammation is gone off the discharge generally 
becomes tenacious, which is a certain sign the patient is
growing better, but the Coats of the Vessels having been preternaturally
distend, it will be some time before they recover their proper tone,
& when they do the discharge will stop; thus Nature endeavours
to get rid of the disease by the very Symptoms which we conceive
constitute it
We may divide the Venereal disease into two Classes,
first where the Cure may be accomplished by Nature, that is to 
say byt the power of the Constitution & 2dly where we mut have
recourse to Art. I am perfectly convinced in my own 
mind


7
mind. Nature will cure a Gonorrhoeal poison, but Nature cannot
cure a Venereal Poison, as I before observed all infectious diseases
have a Process & Conclusion, but Nature here evacuates the fluids & 
the parts are freed from the disease by outlets or [Trans???tion] of
Matter, thro’ the slender coats of the Capillary Vessels if we
take a young Man with a Gonorrhoeal (perfectly in health in every 
other respect) & let him live temperately, & do nothing to increase 
the Inflammation, he will certainly be cured by the powers 
of Nature without any assistance from Art.
Lecture 2nd
The Gonorrhoeal Virus is local, & only affects a particular part, the
Lues Veneria conveys its Virus [into] the whole System, yet
it is possible for [illegible] to have a Gonorrhoea by any thing that
has touched the Gonorrhoeal Virus being conveyed to it, & I know 
a Gentleman that had his nose affected only by using a Handkerchief
that had been applied to the Penis, Inflammation is 
produced by too great a quantity of fluid brought to any particular 
part. the motion of these fluids is accelerated & increased, & irritability
is brought on. Whenever the matter is tinged with blood, you 
may depend upon it there will be an Ulcer. for the Inflammation
is so considerable as not to permit the matter to escape thro’ the 
Coats of the Vessels with sufficient Velocity, the Vessels by this Cause
are distended, & from an increased Motion of the contained
fluids they burst, or to speak Technically a solution of 


8
continuity takes place & an ulcer is formed the first circumstance
that relates to the Cure of a Gonorrhoea relates equally to its prevention
It has been supposed long since that it might be prevented
from taking place; for this purpose Mercurial Preparations 
have been employed, supposing it had a Specific Quality
as an antidote against the Poison, the application of 
Mercurial Ointment to the Penis before Coition has been 
recommended, this the Dr thinks (if it were possible to keep 
it on the whole time of Coition) would most certainly prevent
the Disease from taking place. Dr. Cullen has recommended
(supposing that all poisons lay Dormant for some time) a 
weak solution of Caustic Alkali, he puts a few drops of this
solution into some water, till it is of a sufficient strength
to dissolve the coagulable Lymph of the lips with a little pain 
with this he washes the Penis & extremity of the Urethra, it 
has been used with success but is not always to be depended 
upon, & if not applied with judgment, it will contract the Urethra
& a train of disagreeable Symptoms will follow. [Succ??] [Limon]
mixed with water answers the purpose equally as well, & 
is a much safer remedy upon Calculation this Practice
may prevent two out of three from taking the infection


9
We will now suppose the disease has taken place there
are three methods of cure recommend to us for the Gonorrhoea
1st the use of Injections at the beginning of the disease & so 
stop the runing suddenly. 2dly the use of Mercury considered
as a Specific & 3dly the Antiphlogistic method
We will first consider the use of Injections & their effects;
the Astringent Injection sometimes effects a radical Cure when
the infection is slight & the Constitution naturally good,
this is however but seldom, the running may be stopped for
some time but often returns with redoubled vigor, & 
attended with all the Inflammatory Symptoms, or else
a certain quantity of the morbific matter being absorbed
into the Constitution a complete Lues Venerea takes place 
we will even suppose the patient Cured yet strictures are 
too often formed by this Practice & a train of other disagreeable 
Symptoms, far worse than the disease itself
We will next consider the Cure of a Gonorrhoea by Mercury.
I myself am well convinced that Mercury is of very 
little service in the Cure of a Gonorrhoea (at least in its
Inflammatory state) for my own part I never use it



10
at most very rarely; I give no leave to tell you that it
is a very pleasing thing to assure your patient that you 
give him no mercury. My opinion is, that mercury does 
not possess a Specific to repel the Gonorrhoeal poison, for
take a patient with a Gonorrhoea & give what quantity of
Mercury you please, you will find it only stimulates
the inflamed parts & counteracts the efforts nature is
making for the Cure, whether administered internally or
externally the effects are the same
Now my method of Treatment is, the Antiphlogistic
in which I have invariable been successful, I consider it
only as an Inflammatory disease & give nature her full scope 
she has peculiar powers of her own to Cure this disease, & 
when we are acquainted with the process she makes use
of we shall then be able to assist her. We know that a
certain quantity of fluid is converted into poison & that
Nature has peculiar properties of distributing their
Poisonous Virus & of curing the disease Our first 
aim towards the Cure of a Gonorrhoea must be, to put the
Patient into a good state of health so as to give nature
every 


11
every possible advantage. [Astrue] has recommended
frequent bleeding considering it as a violent Inflammatory
disease, I allow V.S. might remove the Inflammation, but
you at the same time bring on a weak habit of body, & by 
this treatment to Cure a Simple disease, you bring on another
of all the most difficult to remove in this Country we
never consider our patient whilst a gleet remains, yet
it is necessary to lower your patient a little, that the power
of health may be able to act as an assistant; sometimes
bleeding is necessary, but only in a strong Plethoric habit,
the best method of lowering your patient is, by the use 
of gentle purges every second or third day with [Salts] or
Jalap. Sydenham thought the frequent use of Purges
had a Specific Virtue in this disease, & very justly observed
that tho’ you do not eradicate the disease, yet you 
procure a devolution of those Humours which increased 
the disease, he always made use of a preparation
of Jalap The Gonorrhoea has a Crisis and Period
which no human Art can possibly prevent, all that
we have to do, is, to direct our attention to the particular 
Symptoms


12
Symptoms. 1st heat of Urine which is certainly a very
painful Symptom, this arises from the Urethra being 
more irritable & sensible than the other parts, whence the 
salts of the Urine stimulate the parts & cause the pain.
To relieve this Symptom the Patient should take Mucilaginous
Liquors, such as Barley water Linseed Tea etc., but these not
in large quantities, for if given in large quantities you
cause your patient to make water more frequently & 
consequently increase (instead of relieving) the pain
With respect to [Nitre], it has been given with a view
of Cooling the parts & lessening the Irritability & Inflammation,
but in my opinion it has too often the contrary
effect, as it debilitates the Prima Via & acts as a strong Diruetic
I for my own part never use it at all – All Mucilaginous
Liquors are inconvenient to make use of, as they are 
very apt to create [suspicion] the follow in I would wish
to recommend as an elegant substitute, & which may be 
taken without causing the least suspicion
Rx Pulve Tragacanthe
Gum Arabic [aa p.o. cap. gr xvvilxx]
ter quatuor in die 


13
the next & 2nd Symptom is the Chordee, & certainly one of
the most troublesome Symptoms in the disease, it is a violent
pain when the Penis is excited, it generally happens
in the night, owing to the stimulus of the urine upon the
neck of the bladder. various has been the treatment of the
Symptom. V.S. Leeches applied to the part have been 
recommended, it certainly lessens the Stimulus, but
in my opinion does far more mischief than service. The only
thing I ever found necessary in (relieving preventing) a Chordee is
never to let the Penis be erected, the best method to
prevent this is, by passing a Handkerchief round the 
thigh & including the penis within it, this prevents the 
rupture of any of the Vessels, (which often happens in a 
strong erection when the urethra is diseased), & consequently 
prevents an ulcer from taking place. I never found
internal medicines of any service, for my own part 
I have used the following [Fomentation] with great
advantage
Rx 
Fol. [Al??] zii
co q in Lactis [illegible] ad [illegible] f. Foment [illegible]
p.r.n.
I likewise recommend sleeping in Drawers etc.


14
another very painful Symptom is the Hernia Humoralis,
a Hernia Humoralis is a considerable Inflammation running
down from the Vas Deferentia to the Vesicula Seminalis, hence
the swelling of the Epididymis, & the pressure upon the surrounding
parts prevents the discharge from escaping; for as soon as the 
Inflammation is removed the Discharge generally returns.
the Hernia Humoralis takes place either from irregularity
or from the use of Styptic Injections. The relief
from this alarming Symptom is V.S. & the warm bath (a Tepid
Bath I mean), for a hot bath would do much mischief by 
producing a new stimulus; the Advantages derived from the 
above treatment are very great; for in a short space of time
you find your patient easy, the most pleasing & agreeable 
alteration is the return of the running, which is generally the 
case, tho’ you do not find the Tumor much decreased immediately
for the Epididymis may not return to its former state, for 
years, nay it sometimes continues in this state as long as
the person lives, without any inconvenience, if the Inflammatory 
Symptoms & pain are not quite removed it may be
necessary to repeat V.S. & the warm bath, Fomentations & 


15
Poultices are of very little or no service except in the beginning
of the Disease; you must be very exact in recommending a strict
observation to your rules. I am fully convinced that it is absolutely 
impossible to cure a Gonorrhoea soon & radically, yet by regularly
purging your Patient every other day with Salts, you may moderate
the Symptoms & shorten the period; this is all it is in the power
of Medicine to effect & it is an impossibility to prevent the Period
from taking place. I will now mention Injections, what they 
are, & the effects they produce more particularly as I have discarded
them, in the strongest terms. I speak from repeated experience
that no mercurial or Astringent Injection, possesses any 
Specific power, in the cure of a Gonorrhoea. I myself have tryed 
them numberless times but never found them of the least Service
if it is justifiable to use any Injection it should be milk & water
just warm, but even that cannot be used without pain, for my 
own part I never use any; the circumstance of giving pain, is 
sufficient to reprobate their use, as it must certainly counteract
the beneficial effects that medicine might produce, by the increase
of a new Stimulus. Whilst the discharge continues much
[discoloured], & pain in making water etc. Injections ought never
be thought of however at a certain period of the Disease
when the running is not much discoloured, & disposed to be
ropy, when the pain of making water is removed, the Chordee
and all the Inflammatory Symptoms removed you may 
then 


16
then use an Injection prepared in the following manner
Rx
Vitriol: Alb. gr ii
Aq. Fontanae zii
or a weak solution of Sacch. Saturni, but the grand object in 
contemplation, in the use of these Injections, is how to use
them; they ought to be exceedingly weak, otherwise a new
Stimulus is produced. With regard to the Terebinthinous 
Injections I believe they are of very little service at least I 
never saw any good effects from their use. I likewise
in this stage of the disorder, give some agglutinating or 
warm medicines such as the Gum. [Olibin.] Bals. Copaib. etc.
which I have found very useful
Lecture the 3rd
We now come to the Lues Venerea or confirmed
Pox; we consider it not as a Gonorrhoea or Local Disease
but as a disease that affects the whole System
the Virus is similar to a Gonorrohoea Virus, but
\producing effects totally different. It may be produced
different ways, from the imprudent use of Styptic
Injections in a Gonorrhoea by closing up the Orifices


17
of the Vessels of the Urethra, it is impossible to create a Gonorrhoea
from a venereal Virus, but a Lues Venerea may be produced by 
a Gonorrhoeal Virus being retained before its virulence was exhausted;
the most general way of receiving this disease, is from Coition with 
a poxed woman, it is impossible to get the disease by mere contact
of Body, there must be a Contact of Body where there is want o f
Cuticle: a person unaffected with the disease cannot be affected by 
lying with one that has got the disorder, unless the Virus comes
in contact with a part void of Cuticle. The Lues Venerea may be
communicated to any part of the body where there is want of 
cuticle, as for instance where midwives who are obliged to 
deliver women that are poxed, if they have a cut or wound of
any kind, on their finger or hand with which the Venereal Poison 
comes in contact, it is taken up by the Absorbent Vessels, & the
person is inevitably poxd Infants have the disease by 
sucking nurses that are poxed, & Nurses that are not poxed 
may contract the disease by giving suck to poxed Children
there are some Symptoms of the Venereal disease that are
equivocal & admit of doubt whether Local or not
Chancres have been supposed the first & most general 
Symptom



18
Symptom of the Lues Venerea, & has been supposed to 
be Local in that state, but I am confident if it is not
destroyed in its infant state a pox will be soon produced.
The Lues Venerea will sometimes remain dormant for
six or seven weeks; during that time the Poison of the Chancre
may be destroyed by actual [illegible] or cutting of it out
(I believe Inoculation, or the bit of a mad dog may be
extirpated in the same manner provided it is done
before Inflammation has taken place.) I am fully convinced
that the Chancre is merely local before there is Inflammation
but whenever the Inflammatory Symptoms have taken
place, it is out of the power of any topical applications
to be of any service. The Phimous & Paraphimosis
arise from one general Cause, & are symptoms incident
both to Gonorrhoea & Lues Venerea; they are nothing
more than an increased inflammation arising from
different causes, but do not actually depend upon the
Gonorrhoea or Venereal Virus, but an increased Inflammation
from its different Causes The next Symptom to be
considered is, a Bubo. Buboes at their first appearance 
have nothing to do with the Habit, the Ancients supposed
that 



19
that Buboes were an effort of Nature to expel the disease from 
the System a Bubo is nothing more than an Inflammation
brought on the Inguinal Glands by the disease endeavouring to 
pass through ‘em. but not being able to effect this, Inflammation
takes place & matter is formed. this process often times prevents 
the disease from extending any farther. but I think it is the
best method to put your patient on a course of Mercury
immediately, as it is a doubt whether it is Gonorrhoeal or Venereal,
but by pursuing this Course you will soon be able to form a 
judgement Warts or excrescences are most
frequently the consequence of the disease, & not always
a symptom of that injections have been used, they are the most
certain mark that the System has been affected; they have been 
taken for Chancres, but are very different.
We come next to the general marks of the system, being
affected. the first symptom is the Tonsils becoming 
ulcerated; why, & for what reasons they are first affected is not 
known. By what marks are we to distinguish the Venereal
sore throat from the common one? In all Venereal ulcerated
sore throats the health is much affected with Symptoms of 
putrefaction etc. with regard to the Ulcers themselves they are
the same in both diseases; they are at first generally very small
but increase sometimes to a prodigious size in a short time
there 


20
there is a white or yellowish slough at the bottom of the Ulcer
& the edges are of an uneven disagreeable aspect, this
is one of the most common & general symptoms of the
Habit being affected. the next Symptom that makes its 
appearance are the Cutaneous eruptions, now as the Skin
is liable to so many various eruptions of this kind
we ought to be able to distinguish this from any other.
Venereal Eruptions generally make their appearance
upon the Arms & Body, if upon the Head, they are called
Corona Veneris, but there is something so very particular
in the appearance of these Eruptions & so different
from any others that I am convinced by paying a little 
attention you will be able always to form a proper
judgment. they always rise a little above the surface 
of the Skin & are of a dark Mahogany Colour, when
the Cuticle is cracked, you discover a kind of whitish
colour’d Pus lying buried under it. the next Symptom 
which we are to consider is, a most dreadful one indeed,
which are Nocturnal Pains; the Patient awakes about
the middle of the Night, with violent Pains in his Head and
Bones



21
Bones, so as to render him incapable of any more rest that night
& these pains gradually increase untill they become most
excruciating indeed, & if the disease is not counteracted by Art
it generally ends sin Nodes, & [Ex??ses] of the Bones. It is generally 
seated in the Bones of the Head. Having pursued this Disease
thro’ its various changes we will now consider the method of
Cure
Mercury has, & I believe ever will be considered as a 
Specific in this Disorder, it being a Medicine so Violent in
its effects, it requires great care & attention in its Use.
The Venereal Disease is attended with such a variety of 
complicated Symptoms, that Mercury will not always 
cure alone. Mercury is always a remedy made us of 
in this Country, but there are Climates where it is never
used in this disease. In America for instance, they Cure
it by a strong decoction of Guaiacum I will just take 
up a few moments of your time in giving you a short
description of Mercury. it is a metallic fluid different
from any other, it is Volatile in a strong heat, & 
dissoluble in a Nitrous Acid, in its Crude state it would
be impossible for it to mix with the Animal Juices. it is
[endowed] with such peculiar properties that at best 
we


22
we know little of it The Ancient Chymists supposed it
acted principally by its Gravity. But the Moderns think
it acts by its peculiar Stimulating Quality, & by its
contradiction destroys the disease. I am of the modern opinion
in thinking a new stimulus is produced by the exhibition
of Mercury; but it possesses by some means or other
a peculiar Specific Virtus that we are yet unacquainted 
with, of eradicating the Venereal Poison, & expelling it or 
driving it back, if locally applied. For instance a Man
has a venereal Chancre, apply the Ung. Merc. fort. to it &
it will heal [surprizingly]
With regard to the different modes of exhibiting
Mercury the most fashionable method is a solution
of Merc. Corros. Sublimat. it is almost incredible how small
a quantity will produce the most surprizing effects, which 
induces me to think it acts more by its Stimulating
Quality than by its gravity. There are various methods 
of dividing Mercury to make it mixable with the
Animal Juices 1st by Trituration, or dividing it into a
multiplicity of minute parts; tho there are a number of ways 
of 


23
of dividing Mercury, yet I believe the substances with which it
is mixed are of very little consequence, as they all answer the same
use By Calcination you make the most violent strong and
stimulating preperation, the most common of all preperations
of Mercury, is what is called the Merc. Dul. S.S. or Calomel, it is a 
very safe gentle mild Medicine, in regard to the solution
of Sublimate it is most stimulating, & disposes more towards
Inflammation than any other & in my opinion possesses
no degree of superiority over any other preperation
Lecture the 4th
We are now going to the Exhibition of Mercury after 
knowing the circumstances that require its use
(We have before observ’d it may not be amiss here to mention) that in some Countrys
it is cured by vegetables alone, tho’ I believe no vegetable
has that power, if it be any, it is the Sarsaparilla, but this
cannot be depended upon, nothing is so effectual as Mercury.
the Abstract [illegible] Qualities of Mercury, at this time are
not known, & seems to minute to be found out, or even
how it acts, to effect a Cure is uncertain. It may be either 
by its gravity or stimulus, as it appears to act as a 
New


24
new Stimulus on the Constitution, producing at
the same time a change & by this means a Cure is
effected
We will confine the various preparations of Mercury
to six – Three Simple & three Chymical, the three first are
Ung. Merc fort – Pil. Mercurial & [Ath???] Min:
The three Chymical ones are, Merc. D. vel Calomel.
Merc. Calcinat - & Sol. Sublimat
As we are to consider the Venereal Disease as
a very intricate one, & complicated with a variety 
of Symptoms, some of which admit of a doubt whether
a pox or only a Local disease, to be right & successful
in our judgment, we should consider the
Symptoms that are equivocal & admit of a doubt
as a constitutional disease, & determine immediately
upon a Mercurial Course When I see a Chancre
or Bubo, tho’ I may be inclined to believe it partly 
a Local Disease, yet I immediately propose a course of
Mercury 


25
Mercury we will now consider the Patient Poxed; yet I
must observe there is a great deal to be done before you commence
a course of Mercury, at least with safety to your Patient,
We presume Mercury Cures the Lues Venerea by its gravity
or divisibility of parts; or by its producing a new Stimulus
which is the present opinion & I believe the best; the first
step to be taken before the use of Mercury, is to lower your
patient; by this method you gain very considerable advantages,
& the Inflammation you would occasion by not observing
this rule would be very great, by not attending to the above
caution, you run the risk of bringing on a Local Inflammation
which may terminate in a Gangrene; I don’t meant to 
infer, that this frequently happens, but that there have 
been instances of a Phimosis, & a Paraphimosis taking
place & terminating in a gangrene from not lowering
the patient the Mercury is found universally to act better
when the patient is lowered, the first step towards this is,
if the Patient be of a strong Plethoric habit, V.S. & Purge 
freely, & let them desist totally from Animal food, & live
entirely upon a vegetable diet, when you find him 
sufficiently 


26
lowered you than (& not till then) begin with Mercury.
With regard to the Mercury you make us of so various
are the different methods, that I will just say a few words upon
this subject if you make use of Calomel, (tho’ I believe
very few think of using Calomel to cure the L. Venerea)
it requires by far too large a Quantity considerably more 
than the Prima Via can sustain, consequently it Purges
& is of no service therefore we entirely reprobate its use
in the L. Venerea We will next consider Crude
Mercury given by the Stomach.In weak constitutions
where the stomach abounds with large quantities of
Gastric Juices, it always gripes & most commonly
passes off by stool, so that this is likewise discarded.
The method now in use, & the most advantageous is
[I??nction], & may be used with the greatest safety;
(after having observed the rules laid down) it very seldom 
if ever, affects the Stomach or Bowels, & I think I can
with the greatest propriety recommend the Ointment 
to you; as a (Medicine Preparation) capable of doing every thing that 
is required, possessing all the advantages of all other
Preparations


27
Preparations without their peculiar & pernicious Qualities
& having in itself the fewest inconveniences of any other
Mercurial preparation having thus largely recommended
the Ointment, we now come to its use. I can’t help here
observing, that the first Authors, who wrote upon the
Venereal disease, recommended Mercury in the same
manner. The Ointment I would wish to recommend
& that which I myself use is made in the following
manner
Rx
Argent. Viv.
[A?ung.] Porcini aa p.a
Ol. Terebinth g.s. at m
You have by this means a great advantage over the
weaker Ointment, as you Cure your Patients nearly in
half the time. it has been recommended to use the Ointment
on the Legs; but I always use it upon the inside of the
thighs, as it is much mor convenient to the Patient,
& being invisible to external appearances. I begin first
with rubbing in iis or [?ii], ordering the Patient to wear & 
sleep in flannel drawers, but over the part where the 
Ointment is rubbed I wish to recommend a sheet of 
writing 


28
writing Paper to be laid, as it will prevent it
from being absorbed by the Drawers, the greasy part
only being taken up by the paper, whilst the Mercury
is left upon the surface. The first application is generally 
used with little or no effect, the next day you do nothing,
if your patient is weak you allow him a very small 
quantity of Animal Food having rested one day, the following
night you repeat the Ointment this method operates 
differently upon different constitutions, therefore we are
to proceed very gradually least the salivary glands should 
be affected, for a salivation has no relation to the Cure
therefore it is a matter of great importance to proceed 
gradually. It is never necessary to use more than a zi at once,
tho’ in some particular constitutions a very large quantity
is used. in the course of a few days if your patient is not
of an irritable Habit of body, you find the beneficial effects
of the Mercury, by the kind appearance of the Chancre or
ulcer, which is visibly altered for the better, the slough 
gradually lessens, & as it decreases the edges begin to look red, 
and 


29
and young granulations shoot up. you go on using the
Ointment every other day, if your patient can bear it you
increase it from ziis to [?ii], or if you being with zii to zi, no
man can say how long you must continue it, some will
be cured in three weeks, others require 3 months six or eight
weeks is about the average time for a course of Mercury, but 
tho’ all the symptoms disappear, it is necessary to continue
the course of Mercury for 10 days longer I am well convinced
there is no more occasion for a salivation in the care of the
Lues Venerea than in the cure of an Ague. tho’ this method
does not salivate yet it generally affects some of the [E??nctories]
either by salivary glands Bladder or Kidneys. this makes it 
necessary for your patient to drink freely of some warm diluting
fluids; such as Qa. [Flord] etc. to encourage a gentle perspiration,
this diet should be very mild – milk, breakfast & supper,
with Pudding, or a small quantity of Animal food for dinner
You have now nothing to do but to use the Mercury
every third or second day till all the Venereal Symptoms
are vanish’d


30



31
To be certain of curing this disease we do not trust to Mercury
alone – Sarsaparilla blended with Mercury, makes a most
excellent as well as efficacious Medicine when you have used
Mercury about three weeks you then begin your course of
Sarsaparilla; [illegible] a day should be the general quantity, made 
in the following manner
Rx
Rad. Sarsap. [incis] ziii
Aq Font. [illegible] co g. [illegible]
The average time I would have this Decoction continued is
about 40 days By a regular perseverance in the above
method, you invariably cure every Symptom of the Lues 
Veneral The Mer. Calcinat. is a very powerful stimulating
irritable preparation & most commonly affects the prima
Via unless given with an opiate, & where opium will not prevent
its griping quality we give it in the following manner
RX
Merc. Calcin gr ¼
Ext. [illegible] gr ¼
[Specie?] [Aromat] gr S. Syr. g.s. ut fiat
Pil. cap I omni die you may increase the Spceica Aromat
as occasion may require, you proceed in this method for 


38
some time & then gradually increase your dose to ½ a grain
twice a day, which is the most your patient will ever 
bear, this will certainly effect a cure, but has not the least
advantage in any respect to the Ointment
We next come to the Cure of the Venereal Disease by a 
solution Merc. Sublimat. This now prevails as a very 
fashionable Medicine introduced by Baron Van Swieten,
a solution of sublimate in Water then Dr [Saund] recommended
it to be dissolved in proof Spirits, & was generally adopted in this
Country & Germany, till Dr. Cullen of Edinburgh in the Annals
of Physick objected to either of the above preparations, observing
that if the Mercury acted by its Stimulating quality, the 
more Acid & Volatile the fluid it is dissolved in the better the Medicine
tho’ even in this manner it has been known to fail, as well in 
Spt as in Water
This method of curing the disease has a greater Tendency 
to produce Inflammation than any other, & I have known
the most acute pain the Bowels, & violent spasms from
the use of it Wr has made observations on the different
preparations of Mercury & among other he recommends
the following method of preparing it R. Merc Corros sub. gr 64



33
Aq. Font. Distil. zii add Sal Ammon Crud zii cap. gr [illegible] bis in die
in Aq. [illegible] or a Decoction of Sarsaparilla, this does is order’d to
be increased till a sensible change is produce on the Venereal Symptoms
this in my opinion is an improvement on the administering
this preparation & is full as good a medicine as any of the
[illegible] I must observe this to you, that [illegible] solution of Sublimate
seems to have a wonderful effect on the Venereal Eruptions
& is the Medicine most in use, & most efficacious of any
Lecture 5th
We now come to describe some of the appearance and 
Symptoms of the Lues Venerea, but before I begin this subject 
permit me to say a few words upon Crude Mercury, it has
been given at the rate of an ounce per day in the pox with good
success, observing to administer it between meals, or in all probability
it will affect the prima Via; it may be necessary to acquaint
you with the operation of this medicine (as the action of all 
medicines should be known previous to their being administered)
it appears to be triturated as it were with the mucus by the Peristaltic
motion of the stomach & Intestines, by which means some of
its particles become absorbed into the System & produce a 
Cure.
Curing by Antimony was in great use formerly, but
now is quite discarded; but it must be observed that in 


34
Fumigations it has been of very great use in the Schirrous
edges of Venereal Ulcers that are not disposed to heal, for by 
this means the Mercury is let loose from the Sulphur 
& acts alone, in this state of the Ulcer, the Cin. Antimon: appears
from experience to be of admirable use
Of [illegible] I have nothing more to say, than what I have
before related Buboes; buboes are of two kinds, true, & 
specious, the true buboe is that which appears kindly 
like other Tumours, & frequently exists without the Habit
being affected; but this must not always be treated so
I think it is necessary for your patients’ safety & your
own credit, that you never omit treating him as though he
were pox’d, as the matter admits of a doubt. Where there is 
a Bubo which your patient would not admit to come to
Suppuration, if this be the Case it may in its early state
but there is a partial evacuation to be [used], which is repeated
Emetics. it must be observed, Vomits need not consist of
Mercurial preparations, tho’ it was formerly supposed
that Merc. Emet. Flav. had peculiar good effects in this
case, & it has again been disputed how Mercurial Emetics
could have any advantages as they are immediately thrown
from the Stomach, however this may be Tumors are
sooner removed by Emetics than by any other evacuations,
let them consist of what they may, but for what reason 


35
I cannot pretend to say. We will now suppose the Bubo 
proper for opening: there are two ways of performing this
operation. Viz. either by Knife or Caustic; sometimes
when opened by the Knife if the constitution is not good
schirrous edges ensue which render the Cure difficult and
tedious; for this reason I always recommend Caustic, as by 
this means the Bubo forms into an Ulcer & the disposition 
to Schirrous edges is destroyed by Caustic. here the Dr
introduces two very extraordinary cases which fall under
our present observation. “A Gentleman (who had been 
abroad in the East Indies), had two Buboes which put on a 
very disagreeable appearance at the lower part towards
the Perinaeum, but looked very well at the top; they Continued 
spreading at the lower side thro’ the Perineaeum untill they 
came to the Anus, whilst they heated Kindly at the
upper part; he had tried every method for relief that
could be thought of in London without receiving any 
benefit; the Gentleman whose care he was under kept 
him very low upon milk diet, avoiding all manner of 
Fermented Liquors & Animal Food; perceiving he got 
no better he was recommended to his own Country air
Edinburgh (indeed they considered him as went home to do)


36
he accordingly went home & was put under the care 
of Dr. Young. (this man had all his life time lived
very abstemious) the Dr. considering this thought the
only chance he could give him, would be to put him
upon a course of good living, he ordered him to drink
a pint of Wine per day & to live accordingly. in a few
weeks the Ulcers took a disposition to heal & he soon
got well The other case was quite the reverse
“A Nobleman at Vienna who after he had tried
all Medicines in Vain, went to his Estate in the Country
lived as a Peasant & soon got well
The Spurious Bubo & the Bubo with Schurrous
edges, are cured by a course of Mercury & Decoct. [Tarrap.]
& [Mazinon]. In ulcerated Tonsils I recommend the 
Topical applications alone; Mil Egyptiacum & Tinct.
Myrrh, I think is of excellent service, the Ulcer is to be
washed with it & kept clean
In cutaneous Eruptions etc. no Topical applicns
are of any service, Warts & Excrescences taking their
name from their different situations have been 
divided 


37
divided into a multiplicity of Species, but the Dr contents
himself with dividing them into two kinds, the insensible
or Schirrous, & the soft or insensible. I have seen he says
Excrescences very large about the Anus, but soft & painful
& tending to inflammation; if the Patient (having this Symptom)
has not undergone a course of Mercury I put him upon 
it immediately the soft wart (or as Astruc calls it the
Cauliflower wart) may be destroyed by Pulv. Sabin; they will
gradually after a short use of this Medicine be extirpated.
they will not bear the Caustic, for if it is applied it generally 
brings on very considerable inflammation, & they will afterwards 
increase in growth. The [illegible] are totally different, & so far 
as they from yielding to any such treatment, that when the
Vitriol Roman. & other penetrating Medicines have no effect
upon them – they seem more like the growth of Vegetables
than anything else, and they possess a root & branch, so
that if you cut them off from the surface, the Radix is left
behind, & the certainly will grow again. I thought of a liquid
caustic which would penetrate deeper than the surface, & is the
most subtile of all Caustics, this is the Butter of Antimony
I use it thus. touch the warts with a small quantity of
it, & leave it for 48 hours, & if you find no alteration you 
touch 


38
touch it again, & this you will find will make it
softer, larger, and more expanded. you continue this [illegible]
application for some time, & you find it by degrees increase
in size, utill at last it turns out like an acorn out of
its cup.
Pains in the Head & Bones are more difficult of
Cure than any other Symptoms, & are generally the
consequences of repeated Poxes. in this case we are often
baffled in all our attempts; sometimes after every other
remedy has failed, a Decoct. of Sarsapla & [Mezerion] root
has effected a Cure
Nodes & Excrescences generally originate in the
Periosteum, but when they are of long standing they are
very apt to affect the Bones & not infrequently produce
Caries. if it is the bone itself that is affected I think I know
of no Medicine in the World that will be of any service,
but if the disease is seated in the Periosteum alone
Mercury assisted with the Lisbon diet drink. Dr. [Russell]
found this drink very useful in a vast number of Cases 
in 


39
in Nodes & exostosis, but attributes its virtues chiefly to the
[Mezerion] Root which was an ingredient in his prescription, 
a Dr Kennedy who lived near 30 years in Lisbon invented this
drink & made it in the following manner
Rx
Antimon Crud zi
Rad. Sarsap. zii
Rad China
Lapis [Pumic] aa ziis
[illegible] [Inglud] with their shells on [illegible] [Iuglandes?]
cog. in Aq. Purae [illegible] ad [illegible] sumat [illegible] bis die
or thus
Rx
Sarsaparil. Sant Rub. aa zvi
Liq. Rode Quaiae – Sassafras aa zii
Mizerion Glycyrh. aa zi
Sem Coriand Antimon Crud aa ziv
coq. in Aq. Font. [illegible] ad [illegible] sumat [illegible] ter die
But the Dr found both these compositions to affect the
Prima Viae, especially the first. For a simple decoction 
of the Mezerion, he orders a dram & a half of the Cortical part
to be boiled in [illegible] of Az. to [illegible], a simple but efficacious
Medicine, & if mixed with Sarsaparil. does wonders


40
the manner of preparing it is thus
Rx Sarsaparil ziii to zi or zi of the
Mezerion, this is not to be added till near the end of the boiling
as it gives it virtues very speedily; half a pint of this
taken twice a day provided the Stomach will bear it, & persisted
in for a month or six Weeks is an excellent Medicine & 
very successful in all obstinate Cases, & will Cure Nodes,
Buboes, Exostosis etc.
In all Scorbutic habits when the constitution will 
not bear Mercury, the warm Bath with the Mineral Acid
does wonders when the Lues Venerea is blended
with the Rheumatism (which is sometimes the case)
Guiacum may be administered & I think this the
only case in which it will be of service; it must be 
taken very strong & in large doses whenever
a Salivation attends a Course of Mercury the immediate
Course of the Cold Bath is necessary, & I think of very
excellent service in my opinion is much preferable to 
Purging as it relieves every Symptom of Inflammation
We will not take a view of the Venereal disease
in the state of Pregnancy Women in the state of
Pregnancy are often affected & whilst in this condition
Mercury can never be administer’d with safety
except in very small doses 


41
the premature labor is not brought on by Mercury but in 
consequence of the Inflammation it produces. but as
it is unsafe to let it proceed without endeavouring to 
remove its bad effects, we must have recourse to very small
doses of Mercury 1/2 a grain or gr I at night, Purging the Patient
every fourth day with Salts; but if the inflammatory Sympts
should come on, you must immediately desist & put your
Patient upon a Course of Sarsaparilla; & sometimes
by these gentle means we perfect a Cure, & if we do not
cure we keep the disease under. It has been a matter of 
great dispute whether Children are born with the Venereal
disease, Dr. Denman argues that they are not, Dr. Osborne
says he has seen the Children diseased when the Mothers
constitution has been affected by the Lues Venerea, & [Vice Versa]
he has seen very fine health Children born of diseased
Mothers. Dr. Osborne gives the following reason for it
there is says a great disposition in some to imbibe
this disease, whilst in others there is not, as for example
(as we have before aid) there is a predisposition in Men &
Women, one man may have connection with a Poxed
Woman & receive the infection, another man may have
connection with the same woman & receive no injury
Children cured of this disease invariably, by a strong decoct of Sarasp


42
Lecture 6th
It may not be amiss to add to these Lectures on the
Venereal Disease, a train of Diseases subsequent to the
Gonorrhoea; a variety of Symptoms existing in common
tho’ the Virus is banish’d or expelled First a Gleet,
there is no disease more difficult of Cure than a gleet,
a Gleet is a discharge of the fluid secreted by the Glands of
the Urethra, & proceeds from one of these causes, either
a relaxation of the Vessels, or by Ulcers being formed; & don’t
suppose the latter often to be the Case; but I know that
it does sometimes happen that a Gonorrhoea & an 
opthalmic are similar in their process, the Vessels
becoming preternaturally distended they at length give
way & burst, if in the Urethra it is generally longer in the
cure, unless the Penis can be kept constantly in the same
place which is almost an impossibility, as it very often
happens that when an Ulcer is almost healed, an Erection
will tear them open again. after some time the Patient is
free from pain, yet the Disease continues
If the Gleet proceeds from relaxation the Bark Chalybeates


43
Cold Bath, & other restoratives are of great use
The Aq. Alum [Boteii] may be injected with success if
it proceeds from an Ulcer, which is known by the dischrg
being discoloured & purulent when there is no Inflammation
small doses of Calomel may be given & the following
injection made use of
Rx
Calomel pp. zi
Ol. Olivae ziv fiat Injectio.
If the Ulcer does not heal or is neglected the following
Symptoms take place The edges of the Ulcer rise up
above the middle with a Fungus, & you cannot apply
any topical application. It terminates in an Excrescence
or Caruncle, or the edges of the Ulcer may become hard & 
callous, contract the Urethra & so bring on a simple
Stricture. The Disease in this state only produces a
difficulty of making water but afterwards brings on 
a train of very dreadful Symptoms indeed
We come now to the Cure of the Stricture, this must be
performed by dilatation, & upon this principal the Cure
consists, but this dilatation must be gradually & carefully
performed, or otherwise you will bring on Diseases of
more consequence to the life of your Patient


44
The introduction of large Bougies at first is a very 
erroneous Practice. there sometimes together with the
Stricture will arise a Fungus or excrescence, taking
their names from the different appearances 
the Dr has often seen them in Males, & has cut them off
from females – Symptoms when a stricture
only you will find when you introduce the Bougie something
grasping it, as it were, but whenever an Excrescence,
you will find great resistance, & if you continue pressing
blood will ensue, & give pain & uneasiness to the Patient
even sometimes to fainting; so that it will be very easy
to distinguish an excrescence from a Stricture.
A Stricture may come on 1, 2, 6, 8 or sometimes
20 or 30 Years after a Gonorrhoea. The Dr here mentions
a Case of a Man being cured of a Stricture40 years after
the cure of a Clap; & had received no injury in the intermediate
space, so different is their progress. the first complaint
the Patient makes is that he does not make Water freely 
& finds he wants oftener than usual & is longer about it
next an uneasiness in the Bladder which he attributes
to gravel; but from some accidental Cause an Inflammation 
shall take place, either from irregularity or various
other


45
other means; the consequence of which is a total suppression
of Urine, which is dreadful indeed. “A Gentleman eminent
in his profession was called to a Patient in this very situation
he attempted to pass the Catheter but finding great resistance,
he begged the assistance of another [illegible] accordinly another Gentleman
was sent for, who took the Catheter & attempted to introduce
it, & likewise found great resistance, but determined to succeed
he gave the Catheter such force, that by some means or other he
got it into the Bladder (how I can’t pretend to say) the consequence
of which was, the patient was seized with Cold shivering fits
& expired in 48 hours When you are sent for in this
Case (not perhaps considering the original cause) you attempt 
to introduce a Catheter, you soon find great difficulty, but you
say to yourself this must be got over, the consequence of which 
is, by repeated attempts you bring on an additional Inflammation
a Fever follows, & a Gangrene or Mortification takes place & the
Patient dies. You will say what could be done, the Man must
die if he does not make water. the best method in such a Case
as this would be to take the smallest Bougie you can get,
with it you will be able to get through all the obstructions you 
may meet with without any danger; tho’ by this you get but a few
drops


46
drops at first you give the Patient ease, & by this method
will always relieve. We next come to the method of using
Bougies; but first of all, I shall give the Receipt for making
them, at least the way that I always use which I think as 
good as any
Rx 
Cera Flav. opt zi
Ol. Olivae opt zi
Ung. Sambuci zi
having melted the ingredients together you dip slips of 
Fine Cloth into it, & afterwards cut into to what sizes
you place & roll it up upon a Marble Slab
In passing the Bougie you must use great steadiness
& precaution; when you have passed it in you leave it for
10 or 20 Minutes, but if you perceive a disposition to 
inflame, you must keep your Patient very low, not 
permitting him to use any exercise. the next time it must
be kept in an hour if your patient can bear it the next
day it must be kept in a little longer, & so on untill you 
come to four or five hours a day. The operation of the Bougie
is very slow but very certain. It may be persisted in
for two, three, or four Months & sometimes for a year before
the cure is perfected, when you can pass it into the 
Bladder


47
Bladder without difficulty the danger is quite over, & you 
may then keep them in all night. the length of the Bougie
may be about eight inches. This is a disease that requires
a good deal of perseverance to overcome. it frequently happens
we must increase the suppuration for which purpose I
use the Ung. Gum Elemi applying it to the part of the Bougie
which comes in contact with the Ulcer etc. it increases
Suppuration by its stimulus, if after using this three
or four times without effect, I then recommend [the] use of
the following
Rx
Praecip Rub. zi
Ung. e Gum. Elemi zi [illegible] Ung.
It is very necessary to be certain when your patient is
Cured; a decrease of discharge is a certain indication of an 
amendment, & when you find less matter on one part of
the Bougie than another you may be certain the part is 
healing if any of the above mentioned Symptoms should 
return you must have recourse to the same treatment
But I must recommend this to you, that you never 
desist the use of the Bougie once a week during the
patients life time, if you suspect there is any Venl Virus


48
in the constitution you must have recourse to 
Mercury as well as Bougie. I have before said
that the Bladder may be effected sometimes & may 
be diseased various ways an inflammation may be
produced from a [strang???] & I have very little to say
upon this subject, but I must observe that change
of diet sometimes has a wonderfull effect. my treatment
in this case is an absolute abstinence from Animal
Food, & all fermented Liquors giving small doses of
[C??ta] or the following, a Decoction of [illegible] Roots
made thus
Rx
Rad. Comfrey ziii
coq. in Aq. Font. [illegible] ad [illegible]
capiat bis die
Mercury in this Case has been strongly recommended
but in my opinion produces bad effects, & in this
case I never use it
I have now finish’d all I have to say on this
subject. any imperfections you may find in these
Lectures I hope you will have the Candor to excuse
as my willingness to render you every service in my 
power was the only cause of my giving these Lectures



49
Index
A Page
Absorption, Cause of 	5
Antimony, formerly in great use	33
Ancients the manner in which they supposed Mercury acts 22
B
Balne Tepid for what recommended 14
Buboes, from what cause they arise 19
Buboes, two kinds of  34
Buboes mode of Opening 35
Bougies for what recommended 44
Bougies mode of making 46
Bladder, affection of 48
C
Classes two into which the Lues Venerea is divided 6
Chordee the Cure of 13
Chancre, pox produced by 18
Crude Mercury Operations of  33
Caustic for what recommended 35
Catheter bad effects from 45
D
Diet, what most proper 30
Diet Drink Lisbon, for what recommended 39
Diseases train of following the Lues Venerea 42
E
Eruptions Cutaneous 36
Edges schirrous, treatment of ibid
Excrescences, description of 37
F
Fallopius & Cattonellus the two first writers upon the Lues Vena 1
Fumigations benefit of 34


50
G Page
Gonorrhoea whether it produces the pox 2
Gonorrhoea, how long before it makes its appearance 3
Gonorrhoea, first Symptoms of 3
Gonorrhoeal Virus, description of 7
Gleet, an account of the 42
Gleet, what recommended for the 43
H
Hernia Humoralis cause of 4
Hernia Humoralis, Cure of 14
I
Injections the use of considered 9
Injections Styptic bad effects of 14
Injections general effect of 15
Infants how subject to the Lues Venerea 17
K
Kennedy Dr his receipt for the Lisbon diet drink 39
L
Lues Venerea first discovery of 1
Leeches for what recommended 13
Lues Venerea considered 16
Lues Venerea appearances & Symptoms of 33
Labor premature how brought on by Mercury 40
M
Mercury when first found a Specific for the Lues Venera 2
Mucilaginous Liquors for what is recommended 12
Mercury description of 21
Mercury the Exhibition of 23
Mercuries Calcinatus recommended 35
N
Nature [illegible] it makes us of to get quit of the disease 6
Nitre the use of considered 12
Nodes from whence they originate 38


51
P Page
Prima Viae Nitre bad effects on 12
Phimosis & Paraphimosis how produced 18
Pregnancy the treatment of the Lues Venerea in 45
R
Russell Dr his receipt for the Lisbon Diet Drink 39
S
Sydenham’s treatment of the Lues Venerea 11
Sacchar. Saturni for what recommended 16
System in general marks of its being affected 19
Salivation considered 30
Stricture cure of 43
U
Urethra described 3
Urinae Ardor, cause of 12
V
Vena Section considered 11
W
Warts Venereal, from what cause produc ed 19




Medicamentorum Formulae
in varias
Medendi Intentiones Concinnatae
Auctore
Hugone Smith M.D.
Colleg Regal. Medicor Lond
Edition Secunda Auct
Londini Typis Josh Kippax


Formulae
Medicamentorum
Plethora
The diseases from Plethora have been supposed to owe their
origin to a preternatural fullness & distension of the sanguineous 
vessels, from too great & increased a quantity of blood in general; but
upon a more minute inquiry, it will perhaps appear more probable,
the the phenomena in plethoric cases, will depend upon the 
superabundance of the fibrous crassaminturn, or the other parts of the
blood, in proportion to the serous or thinner: From an excess in the 
quantity of the fibrous parts, the blood becoming too thick and
dense, can with difficulty be circulated through the smaller capillary vessels;
or propelled from the extremities of the venal into the artereal system, 
whence a distension & dilatation of the arteries, an impediment to the
free, easy, & ready circulation of the blood, an increased assistance
to the force & action of the heart, ruptures of the vessels, (especially
in those parts where they are most fine & tender, as in the Brain
& lungs) observations, suppressions, [prevented] secretions and
excretions, haemorrhages, vertigos, appoplexies, & even death itself
The predisposing causes to a plethora, are a good constitution
& a sound & strong state of the vessels, & viscera, more
especially if a greater quantity of nutritious aliments shou’d
have


1
have been indulged in, than suffice for the support & nourishment of the body,
or if a natural, or an accustomed artificial evacuation of blood shou’d have 
been suppressed or neglected.
The curative intention will consist in depleting the vessels and
attenuating the dense rich blood, and this can only be effected, by copious blood
lettings & lenient purges, the volatile & neutral salts & plenty of warm
diluting liquors may likewise be given to advantage.
Inflammations & Inflammatory 
Affections in general
In the beginning of a febrile inflammatory disease, the pulse is
quickened & soon becomes full, tense, & hard, beyond its natural state;
an evident indication of an increased velocity of the bloods motion and
of the Vis Vita being enforced beyond its due bounds.
This can only happen from an irritation more or less general,
of the fibrilla of the vessels, & brought on by some cause acting as a
stimulus. The causes may be divided into external & internal.
The external or mechanical causes are various, such as wounds,
bruises, a thorn, or any foreign body push’d into & lodged in the flesh
etc. But as inflammatory diseases often times attack the animal
machine, when not only as such external causes appear, but also 
when no such similar causes can be assigned, or even supposed to 
happen to the internal parts; we are therefore obliged to have recourse
to a deeper research, to explore a cause both sufficiently general  
and 


3
and adequate to such effects. And their general cause perhaps no more 
than an obstructed precipitation, or a stoppage of the cutaneous excretion
by cold, which generally proves the occasional cause of our internal
inflammatory, & other acute febrile complaints.
Every inflammation must either be terminated by Resolution,
Suppuration , or Gangrene. Of these, Resolution is by far the most
eligible & desirable event, & ought by all means to be promoted, especially 
if it should happen in an internal part, or any of the Viscera.
To procure this desirable termination by Resolution, our first attempt
must be to reduce the febrile impetus to proper bounds, & to remove, or at
least to diminish, the cause of the disease, & abate the increased oscillatory contractions
of the vessels; to effect which, blood letting, especially in the beginning, is one
of the most powerful means, & must be repeated according to the urgency
of the Symptoms & violence of the Fever.
Afterwards, to promote the excretions and expel the cause of the
inflammation, the reguline preparations will prove highly beneficial
& claim the preference to all other medicines. It will be best to give them
in such doses as will gently puke the patient, & repeat them at the distance
of twelve or sixteen hours for once, twice, or at most three times.
Rx
Tart. Emetic gr [illegible] ad gr [illegible]
Calc. Antimonii [illegible] m. f. Pulv.
vel Rx
Regul Antimon
Nitri aa p.a. seperations in pulverum trita probe
misceantes, deinde gradatim injeciatur mixtura in [??ibulum] [illegible]
[illegible]



4
[candens]: motirea ab igni remota, aqua bulliente abluater, & in pulverim
subtilissimum reducatur
Rx
Pulv. ut supra [illegible] ad [illegible]
Merc. Corrolini gr 1 m. f. Pulv.
In the above preparation it is immaterial whether the Regulus, [illegible],
or Glass of Antimony should be made use of.
In the intermediate time
No 2
Rx
Sol. Abinth. [illegible]
Succini Limoni [illegible]
Aqua Prua [illegible]
Alexit. spir.
Suyr. Croci aa zi m. f. [illegible] 6th quaq. hore [illegible]
adde pro re nata Nitre [illegible] ad [illegible] vel Sp Nitri dul. [illegible] ad [illegible] vel Vin. Ipecac
[illegible] ad [illegible]
If the patient should prove costive, & the intestines should not be [illegible] 
by the above, it will be necessary to procure a stool, whether by an emollient laxative
Clyster or an [illegible] purgative
No. 3
Rx
Decoct. Commun. [illegible]


Elut. Linctiv.
Ol Olivae aa [illegible]
Vin. Antimon [illegible] m f Enema
vel
Rx
Aq. Tepid [illegible]
Sap. Mollis [illegible]


51
No 4
Rx 
Sal. Cathart. Glaub zvi ad zi
Manna [illegible] solve in Qa Purae [illegible] adde
Tinct. Cardamomi [illegible] [illegible]
Vel
Rx
Tart. Solub. [illegible]
Manna [illegible] solv in Aq Pura  adde
Aq Cinnamomi spir.  m.f. [illegible]
vel
Rx
Infus. Linae. Limonicat. [illegible]
Sal. C.C. Vol. [illegible]
Tinct. Carcamomi [illegible]
Manna iii solv ut
fiat [illegible]
vel
Rx
Emulsio commun [illegible]
Manna [illegible]
Tart. Solub. [illegible]
Sp. Nitri [illegible] [illegible] [illegible]
sumat [illegible] omni vel secunda quaq hora, donee satis purgavents
When the Pulse is lessened by the evacuations, the
Sal. C. C. may be given to advantage in doses of gr xo [illegible] either
in the Saline Draught No 2 or joined with a solution of the Sp. [illegible]
which tends to blunt its acrimony, & render it more palatable.
Towards the end of the disease if the Pulse should flag,
the free use of blisters will be advisable & the Antiphlogistic Regimen
must be changed for the warm Cordials 


6
To the Sal. C. C. may be added the Conf Card., Castor, [contrag???]
Camphor, Saffron & the like, (see Nervous Fever) as the indications
will now consist in supporting the powers of Nature, & exciting the
Vis Vita.
Topical applications such as Fomentations,
Cataplasms, Liniments, & the like will become useful 
in relaxing the tension & abating the increased oscillatory contractions
of the Vessels.
No. 5
Rx
Flor. Chamameli
Capit. Papav. alb. contus
aa zii Aq Pura [illegible] liviter [illegible]
& cola pro fotu tepide [illegible].
Cataplasms of Breast Milk with oil of Roses
or ointment of [illegible] may be applied to the part & renewed morning
& evening, or the following may be substituted
No. 6
Rx
[Flord.] Gallic 
Lin. [illegible] zii tere semul & coque ex
Lact. Vaccin. zvi vel zviii ad debitam consistentiam adde Ung.
Flor Sambue q.s.
No. 7
Rx
Ol [illegible]
Sp. Sal. Ammon aa i
m. f. Liniment
vel
Rx
Ol [illegible]d Ung. Simp. aa zi
Camphor zii ut fiat Liniment


7
To [illegible] the strength of the Patient, the remedies
to be proposed for the Cure of weakened & relaxed solids will be 
advisable 
Convulsions & Spasms.
An involuntary or morbid contraction of any 
muscle, is called a convulsion. This can only happen from an
increased, & irregular termination of the Nervous influence into
the Muscles of the affected parts, which is either owing to an 
irritation in the Encephalon itself, or upon some other part of
the Nervous system: also to passions of the mind; to inanition, or an
emptiness of the Vessels from profuse evacuations; or to a weakness 
& laxity of the Nervous & Muscular systems.
Spasmodic Complaints are sometimes attended 
with pain & others not.
A Spasmodic is to be distinguished from an 
inflammatory pain by an attention to the Pulse & the nature
of effects of the Pain itself, the Pulse in an inflammation is always
quicker, & generally fuller, hard & tense, the pain likewise is equable
throbbing, & intermitting; But in a spasmodic affection the Pulse is often
a natural one & the pain is mitigated at short intervals & returns
more violently by fits.
In painful Spasms, Opiates claim the first
place & should be given in large & frequent doses.
No. 8
Rx Conf. [Paulin] [illegible]
Castor Misch [illegible]
Syr. Croci g.s. ut fiat Bolus 6ter quaq hora


8
vel pro re nata [??mend].Or a gr or ii, or in some Cases even three of Opium 
may be given at a dose, & repeated as often as necessary. Clysters made of Both
or the like; with two or three [illegible] of Tinct. [Theba??] will sometimes be highly 
useful. Blisters & Sinapisms are often serviceable more especially in such 
convulsive complaints as are not attended with great pain, in which Cases
likewise the [illegible] & Antispasmodics may be used to advantage
Asaofoetida may be given from [illegible] to [illegible]
Camphor [illegible] ad [illegible]
[illegible] [illegible] ad [illegible]
Ol. Animali [illegible] ad [illegible]
Volatile Salts [illegible] to [illegible]
Salt & Oil of Amber [illegible]
Valerian [illegible] to [illegible]
Strengtheners & bracers, the Bark & Steel.
In general if we can remove the Cause the effects will cease
Weakened & Relax’d Solids
The Causes of relax’d solids or a weakened habit
of body, may be comprehended under five Classes & will either
depend upon First, a defect of Nutrition, either from improper 
food, or an insufficient quantity thereof, or upon an Inertia & 
weakness of the Digestive powers
Secondly, a languid circulation, or too weak an
application of the parts of one fibre to another, from a defect of
muscular motion. Thirdly great & profuse discharges either 
by spontaneous or accidental Evacuations, & this either of the 


9
blood itself, or any of the Excretions preternaturally increased
Fourthly, Passions of the mind or too close an attention 
to any particular object, especially if joined to an inactive 
sedentary life or Fifthly, An over distraction or distension 
of the Fibres & Solids of any part of the Body so that they 
are not again able to recover themselves.
The Symptoms from relaxed solids are such 
as must evidently result from an impaired debilitated state
& action of the several organs & Functions of the Body from
a weakened state of the Stomach & Prima Via, loss of appetite
indigestion, Flatulences & Acidities. From a debilitated Action of
the circulating powers of the Heart & vascular system a languid
circulation, an increased secretion, from the weakened organs, & 
from a weak absorption. Whence palpitations of the Heart,
shortness of breath, a general indolence & weariness, Obstruction,
Fluor Albus, Haemmorhages, a bloated countenance and
dropsical swellings; And from a weakened state of the Nervous
System, extreme lowness & digestion of Spirits, tremblings, Spasms
& the like. The cure may be comprised under five Heads
& may be attempted
First, By diet. Secondly by exercise of
Body, Thirdly by bracing & strengthening Medicines
the [austere] & astringent vegetables & Minerals. Fourthly 
by topical applications & Cold Bath the proper application


10
of bandages & the like. Fifthly, by lessening or removing the distracting
or distending Cause.
A proper diet for debilitated & weakened people
may be prepared from Milk Eggs, [D??ction] of Bread, Jellies, Broths etc.
The whites & Yolks of new laid Eggs well beat together may be diluted 
with half a pint of Milk seasoned with spice & sweetened with Sugar
to the taste of the Patient. [Panad] as prepared from Brad, Biscuit
or Dutch [rusks], with Sugar & Rhenish Wine, or Lemon & Orange Juice
are agreeable & useful. The Beef Tea as it has been called, is a
pleasant & proper liquor, it may be prepared as follows: cut a
pound off the lean part of a buttock of beef into very thin slices, add
to it a quart of Water, put it over a quick [fire], let it boil five minutes
take off the rising Scum & decant the clear liquor for use
The bracing strengthening Medicines which most
powerfully conduce & are but adapted to the Cure of a relaxed state
of the solids, are as follows
Iron or Steel, & its preparations
The Vitriolum i Cupro
The Peruvian Bark
The Cortex [Quircus]
Allum
The acid Sp. or Oil Vitrioli
The Terra Japonica
The Sanguis draconis
Most of the Aromatic bitters


7
The [P??mont], Spaw, Tunbridge & other Chalybeate
Waters.
No 9
Infus. Amar [illegible]
Vin Chalyb. [illegible]
Sp. Lavende [illegible]
m. f. Flaust. hor xi matut. [illegible] p. [illegible] sumend.
Rx
Ext. Cort. Peruv. [illegible]
Coleoth Vitrioli
Limat. Chalyb. [recent] aa [illegible] gr xv
Spic. Aromat gr vi [illegible] simp. q.s. ut
fiat Bol mani & [illegible] sumend.
Rx
Cons. Cort. Aurant. [illegible]
Limat. Chalyb. [illegible]
[illegible] Spec. Aromat  gr [illegible]
Syr. i Cort Auirant gs ut f. Bolus
mane & vesperi sumend.
Rx
Conserv. Abs. [Ma?tim] [illegible]
Flor. [Ma?] [illegible]
Pulv Ari. comp. [illegible]
Sur. i Cort. Aurant q.f. ut fiat [illegible]
sum. quant. n.m. mane & vesperi



8
By Sol. Chalyb. [illegible] calinat. lini igni in vase [illegible] donee
[illegible] incipiat [illegible] affund dum adhere [cal??cit] Sp. Vin. Gallic. [illegible] [illegible]
per 3 vel 4 dies & Cola pro [illegible] [illegible] vel [illegible] bis die.
No 10
Rx Tinct. Saturn [illegible] sumend [illegible] ad [illegible] ter quatuor
in die.
Rx
Vitriol [C??l] [illegible]
Pulv. [Succini] [illegible]
m.f. Pulv. [illegible] [illegible] ad [illegible] ter quatuor in die
Rx Vitriol. [Carul] [illegible]
Aq. Cinnamoni [illegible] [illegible]
solve ut fiat Tinct. [illegible] [illegible] ad [illegible] ter quatuor in die
No
Rx Pulv. [Cort.] Peruv. [illegible]
Flor. Balust.
[illegible]
Cinnamomi aa [illegible] [illegible]
Vin. Rub. aust. [illegible] digere & cola dos [illegible]
ter quaterve in die.
No 12 Allum.
Sang. Dracon aa [illegible]
Rhabarbari gr grv. Syr. Simpl. q. f. ut
fiat Bolus quarter [illegible] die sumend. [illegible] [illegible] [illegible] Rosar [illegible] vel [illegible]
No 13 Rx Elix. Vitrioli [illegible] [illegible]
[illegible] Amar [illegible] [illegible]c p. [illegible] vel [illegible]
bis [illegible] de die ex Vini [illegible] vel vino mediat. No [illegible]



9
The Rickets
The Rickets are a disease to which Children
alone are subject from the 4th month to about the 5th or 6th year
of their age: it is owing to laxity; & brought on by the Causes which 
have been assign’d as productive of relax’d solids in general.
May be distinguished by a general weakness a relax’d &
bloated countenance, a curvature of the Bones & an enlargement
of their.
The indications of Cure will consist in 
strengthening habit, & restoring to their tone or figure, the parts
which may have been vitiated or distorted.
As from the Relaxed state of the Prima Via, a quantity
of [pituitous] humors are for the most part lodged in the
stomach & Intestines, a few grains of Ipecachn. as an Emetic
may be administered; & now & then a gentle purge of Rhubarb
with nutmeg, the Elix. Aloes, Tinct. Sacrae, or some other warm
stomachic purgative. But we are principally to depend 
upon the bracing strengthening regimen Chalybeates, Bark
the Cold Bath & exercise of the Body. The Chalybeate preparation, 
No 9 in proper doses according to the age of the Patien, will 
be extremely advisable. The Mars Saccharatus of the Edinburgh
Pharmacopeia, which is an elegant & agreeable form of Chalybeate
for Children, may be given from a [illegible] to [illegible] three or four times
a day.


10
The infusion of the Bark No 11, with or without the Elix. Vitriol
will be useful, ore particularly if any feverish heat or [??ctical]
symptoms should forbid the use of steel, till their removal
The distorted parts may be restored again to their
figure by Mechanical Instruments of different kinds, contrived
to counteract the traction of the Muscles.
The Dropsy.
The indications of Cure in a Dropsy consist
in removing the cause of the disease in evacuating the Waters 
diffused in the several cavities & in preventing a relapse by 
strengthening the solids of the Body, & guarding against a future
collection. The Waters are to be evacuated either by the natural 
emenetories, or artificial outlets. The natural excretions are those
by vomit, Stools, Urine, & Sweatg. The artificial are by the operations
of the Empyema, the Paracentisis, Scarrifications & Blisters
Proper Forms for Emetics.
No 14
Rx Pulv. Rad. Ipecaco. [illegible]
Tart. Emetic gr [illegible] m f
Pulv. Emetic.
Rx Vin. Antimon. [illegible]


[illegible] [Scillit. [illegible]


11
Rx Pulv. Rad. Ipecacuh. [illegible]
Merc. Emetic flav. [illegible]
Syr. Simpl. g.s. ut fiat Bolus
A Cordial Opiate may be administered after the operation
of the Emetic.
Hydradogue Cathartics.
No. 15 Rx Tinct. Jalapii
Syr i Spin. Cerv. aa [illegible]
Aq. Cinnamomiten [illegible]
tinct. Aromat. [illegible] [illegible]
Rx Scammonii [illegible]
Gum Guaiaci [illegible] solutl vitil [illegible]
adde Aq. Cinnamo. ter [illegible]
Nuc. Mosch. [illegible]
Syur. Rosas. Palid. [illegible] m. f. [illegible]
Rx. Elaterii [illegible]
Sacchari [illegible]
Col Juniperi [illegible]
[Co??] Cynorb. [illegible] m. f. Bol.
Rx Jalapii [illegible] Gum. Gamb. [illegible]
Zinzibar [illegible] Syr. de [Spin.]
Cerv. q. s. ut f. Bolus.
Rx Rad. Iridis lutei q.f. [cont??de]
& [exprieme] [succ??] dos [illegible] ad [illegible] mane & [illegible]


12
Rx Scamon opt. [illegible] [illegible]
Antimon [illegible]
Chalyb [illegible] Sulph. [illegible] aa gr [illegible]
Syr. Simpl. q.v. ut fiat Bolus [illegible] dieb. sumend.
It may be useful in a many Cases to subjoin Calomel
to the above Purges, of which [illegible] or [illegible] may either be given in a Bolus
over night, or joined with the Cahtartic.
Diuretic Medicines
No 16 Infus Amer S. [illegible]
Sal Diuretic [illegible] vel
Salis Tart. [illegible] m. dos [illegible] ter quaterv in die
Rx Aq. Pura [illegible]
Sal. Succini [illegible]
Tinct Cantharad
Syr. Croci aa [illegible] m. f. [illegible] [illegible] quaq hora [illegible]
Rx Lac. Ammon 
Aq. Cinnamoni [illegible] [illegible]
Sp Nitri d. [illegible]
Syr Bals [illegible] m. f. [illegible] [illegible] [illegible] hora
sumend.
Rx Aq. Cinnamoni [illegible] [illegible]
Acet. Scillat [illegible]
Sp. Lavand
Syr. Croci aa [illegible] m.f.
[illegible] t.d. sumend


13
It is necessary in Hydropic cases to join the stimulating
acrid, & Aromatic Medicines, with our diuretics: Such as 2931130R_000075
Radish, Mustard seed etc.; in order that the extravasated fluids 
may the more readily be absorbed & determined to the [Kidnies]
Sudorific Medicines
No 17
Rx Pulv. Rad. Ipecac [illegible]
Sal. Ammon. [illegible] [illegible]
Ext. Thebair [illegible]
Syr. Croci q.s. f. Bol. nocte hora somni
sumend. repet. mane vel nocte sequent ut opus erit
Rx
Tart Emetic [illegible]
Ext. [Thebaii] [illegible]
Gum Guaicii [illegible]
Camphor [illegible]
Syr. Croci q.s ut fiat Bolus mane
& vesperi sumend.
To strengthen the solids, & prevent a
future collection & extrvasation,t he Regimen & Medicines
recommended for the remedy of weakened & relax’d solids will
be highly advisable & bid the fairest to answer the intention





14
Of the Spontaneous
Morbid Degeneracies of the Fluids.
The fluids & humors of the Body from various Causes
may become either acrid, Glutinous, or putrescent. An acrid Acrimony prevails 
principally in the Prima Via, & may derive its origin either from too great a
quantity of [a???scent] food, or from a laxity & debility of the Stomach, & Organs
of digestion. It is to be remedied by diet, by the anti acid Medicines, & by 
strengthening the Prima Via; by which digestion may be hastened & the
aliments prevented from turning sour.
The acid is to be corrected & weakened by those
remedies which absorb & neutralize acids; such are the volatites & fix’d alkalies
& the [illegible]
No. 18
Rx Julep i Creta [illegible]
Tinct. Cinnam. [illegible]


m. f. [illegible]
Rx. Tert. [illegible] [illegible]
Sacchar aa [illegible]
Ol. Cinnam. [illegible]
m. f. Pulv dox. [illegible] bis
terver in die.
If it should be judged necessary to procure a stool at the same time
Rx [Magnes] Alb [illegible]
Rhabarb [illegible]
Spec. Armoat. [illegible] m. f. Pulv mane & [illegible] vel p.r.n. sumend
Rx Vin. [Aloct.] [illegible]
Aq. Cinnam. ter aa [illegible] m. f. [illegible] mane & vesperi
sumend.
But the greatest indication will consist in strengthening the
Prima Via and hastening digesting; by which the aliments will be 
more quickly expelled from the stomach & prevented from becoming 


15
sour. The others were only palliative & preventative, but this
must prove the Radical Cure.
If the Stomach should be foul & a sickness or 
Nausea attend, an Emetic may be given (& occasionally repeated) 
of ten or 15 grs of Ipecacuanh. or a decoction of the Bulbous Root
of common daffodil, which is one of the mildest & most efficacious
Vomits the whole materia medica affords.
The Stomach Purges; such as the [Alo?ties]
& Rhubarb will likewise be useful; The Tinct. Sacra, the Tinct. Rhei
or the Vin. Alock [illegible] [??rned] with Sp. Lavend or some other Aromatic
may be given to an ounce, either in the morning or at night at bedtime.
The Elix. Aloes may be taken to half an ounce & the
Pil. [Rufi] or Aromatic Pill to 15 grs or [illegible]. The bracing 
strengthening Medicines will be likewise advisable particularly 
those of Iron, & also the Chalybeate Waters. The Bark the Elix Vitriol.
the Stomachic bitters & exercise of Body see No 9, 11 & 13
A Spontaneous Gluten
As a pituitous [illegible] in the Vessels & Viscera may derive 
its origin from viscid Aliments, & weak prima Via, or, maybe
owing to a degeneracy of the humors themselves, from a weaken’d
circulation, or too rigid a state of the Vessels, the effects of age.
The Cure is to be attempted by cutting off the [illegible]
of the disease; expelling from the prima via the [illegible] [illegible]
attenuating the [illegible] of the Blood, & strengthening the Solids
to prevent a Relapse. A proper diet opposed to viscidity, will 
be necessary to cut short the morbid [illegible]. Hence Animal 


16
& well fermented, & seasoned Foods, & spiritous liquors may be
moderately indulged in.
The Saburra may be expelled from the Prima
Via, by gentle Emetics, & stomachic Purgatives, the Aloetics & Rhubarb.
The [Lintor] or the fluids is to be attenuated by exciting
the action of the Vessels upon their contents; by which means the Circuln
thro’ their smaller branches, will become brisker, the viscid particles
resolved, & a due degree of fluxidity being obtained, the obstructions & 
pressures will be removed & the vessels & organs cleared from the [piturtary]
[Colluvis].For these purposes the resolving, stimulating, acrid, and
Japonaceous Medicines become useful
The fix’d & volatile alcaline Salts
The Neutral Salts
Soap. Borax. Mercury
Millipedes Cantharides G. Ammoniaum, Asafoetida, Myrrh,
[Sagapenum], Benzoin, Mustard Seeds.
The Roots of
[illegible] Birthwort, Garlick
Ginger, Horse Radish, [Pellitory]
Squill, Turmeric, & [Zed??ry]
The weakened organs are to be strengthened by the Bark, Chalybeates
exercise of Body, & the Medicines that have been already mentioned
for the Cure of relaxed solids.


17
Fevers in General.
In every fever the Pulse becomes quicker
than natural, & the functions of the Body more or less impaired
or vitiated. The Causes of Fevers will be then such as
by their irritation can quicken the circulation, & excite
spasmodic contractions in the several parts of the body
And these we may distinguish in a twofold manner,
into general & particular. The general or Epidemic causes
of Fevers are such as may affect a whole Country, City, or
Family, & for the most part depend upon some putrescent
or infectious particles lodges in the Ari, or upon its manifest
qualities, such as its heat or coldness its moisture or dryness & 
the like. The particular Causes of Fevers or such as will 
affect individuals only we may refer to three Classes viz
1st to a purulent [illegible] within the body, from confined matter
the consequence of Suppurations. 2d To a putrescent, acrimonious 
state of the Juices, from a putrid [illegible] of any kind, & 3d To obstructed 
perspiration.
From the first class, Fevers of the [?ectual] kind,
will derive their origin; From the second, Fevers of the putrid
or malignant kind, & from the third Class, according to the
habit of body & constitution of the Patient, either the acute
inflammatory, the low Nervous, the Rhumatic, or the
intermittent Fever.
The curative indications in Fevers in general 


18
may be of three kinds. The first to correct & expel the cause which 
by its irritation had given rise to the Fever. The second will depend 
upon a proper management & regulation of the powers of Nature; 
that the febrile impetus should not prevail beyond due bounds
or too much flag, for the proper coition of the febrile matter
The third will consist in providing for the relief
& mitigation of the most urgent Symptoms
It has been a received maxim in Physic that 
if the cause is removed the effects will cease. Our first attempts
then in Fever, should be to correct or expel the cause of the disease
Hence if a purulent or putrescent [fomis] in the Habit
should have given rise to the Symptoms, they are to be removed
or corrected by their particular Antidotes; but as the cause 
by far the most frequent, depends upon obstructed perspiration
it becomes a matter of moment in the Cure of Fevers to restore
the excretion, & expel the retained acrimonious humors which 
had occasioned the Disease.
For this purpose especially in the
beginning of a febrile complaint, the preparations of Antimony
(see No 1 page 3) exceed any remedy we are yet acquainted with, & 
often tend to the speedy removal of the disease
The second indication viz that of regulating
properly the febrile symptoms, will become a matter of moment
in the Cure of Fevers, as the disease itself rightly moderated 


19
& restrained within proper bounds & limitations is the 
best remedy for the coition & expulsion of the morbific
Cause; for art can only avail in regulating properly the powers
of life & the circulation, that the febrile impetus may not
so much prevail, as by the increased circulation to prove
fatal to the body, or, on the contrary, that the powers of
Nature may not so much languish & flag, that there
should be wanting the necessary degree of Fever for
the proper coition & expulsion of the irritating [fomis]. So
lower the Impetus of a Fever evacuations & the remedies
recommended in Page 3, 4, & 5, will be advisable. To
promote & increase it, the warm Cordial, heating & stimulating 
Medicines, the aromatics of different kinds, saffron, Castor,
Camphor, Wine & the like, see Nervous Fever.
The symptoms the most frequent and
troublesome in Fevers are as follows.
In the beginning a sense of coldness
& shivering







Mr John Hunter’s Lectures
T.T.
1780




1
Lecture 1st
Matter is but an abstract idea, as we are 
only acquainted with certain properties of it, which makes
us to suppose it exist. By matter is meant the world, which 
is composed of several substances, all of which we rank under
general properties. (viz) the properties of simple attraction, & 
attraction of cohesion, & also elective attraction, which last
constitutes Chymistry; also magnitude figure, solidity etc. which with
their application to one another constitute mechanics. Repulsion
is rather suspected not to be an universal principle. There are
the properties of rude matter. But matter has undergone such 
changes, as to form as it were a new Creation, between which & [illegible]
no traces have been even supposed to exist.
Bodies which have internal growth & action, & power of
propagating as animals & vegetables, which have the same first 
principals, & have marks that distinguish them. Animals can only 
be nourished by the dead of both, whilst vegetables seem only to be nourish’d
by water, which would seem to prove that fluid to be different from common
matter. This matter may be either dead or alive & may be consider’d
in three views (vis) as alive, simply as matter, & in its decay
The consideration of matter as living is a very extensive field, &the 
properties entirely distinct, the which it will be necessary to know before we
treat of disease.
Animal matter is endowed with life, which is either something 


2
superadded in this modification, or arises out of a certain arrangement 
of it. magnetism seems to explain this reasoning.
Life is in every part, independent of any other, & yet is essential
to it, & is the preservative of preservation, which can exist without action.,
Before which can take place, the parts must be disposed into form, which 
disposition of living particles is organization, & the parts are formed to
support the intended actions; & it is the power of action which distinguishes
the living from the dead.
Sensation is a power superadded, which is either active or passive
(vis) the power of receiving impressions, & the will, which arises out of it,
Sensation rules our external action, & life our internal ones, & they are
very much connected, which produces compound principles, & when 
both these principles are in vigour & harmony the machine is in
health. The compound actions do not take place ‘till
sensations assist, which most probably is not in the womb. One
class of them is called instinct, which is either when the voluntary
actions are affected by the living, or Vice Versa When the living principle
is in want & must have the assistance of the voluntary, it is only 
producing a sensation on these voluntary parts & the action is performed 
as in a Child sucking etc.
The second set are illustrated by fear, anger, & love, which 
are capable of affecting its living principle considerably. A singular
effect of our being [illegible] by sensation is sleep, which is a total
Annihilation


3
annihilation of all its powers, as a Swoon is to the living, it is a material
circumstance in the sensitive part of our constitution & makes one third
of it, & is the [winder] up of sensation, & as far as the two principles
are connected, life can be affected by it
Life can go on without sensation, tho’ not always with it, & it
is a fatigue to life, & in proportion to its exertion in a given time, life
is sooner wasted.
Sensation is so far a property of the brain, that those animals who 
have no brain never sleep, when in health sensation stops at a proper 
time, & life appears at ease, but sleep is often encased or diminish’d by 
disease.
Lecture 2nd
Habit is a second principle in the Machine, & it 
becomes the cause of continuance of actions both of the body & mind, and
of health & disease. The habit of diseases of two kinds (viz) first of rest
from continuance of disease, the parts from habit becoming sensible of the
Disease, as in Bug & Mosquito bites. secondly, the disease from habit
continuing after the original cause is gone off as in Gleets
The climate has considerable influence on animal bodies so as
to produce disease, especially cold, as in Scrophula &  Venereal Disease
which last is assisted by it.
So far we have considered solid matter


4
The blood has been considered as a passive in animated fluid
which was not adequate to their own ideas of its uses, it has been merely 
considered in its spontaneous changes out of the body, in its chymical
analysis & magnified in a microscope. The first might have made
them draw some natural conclusion, the two last have hitherto 
thrown no new light upon the subject.
The nourishment must undergo two changes sometime
or another (viz) animalization & Vitrification. Animalization certainly 
goes on in the stomach called digestion & most probably vitrification
goes on there also, as it must take place somewhere; if it is supposed
to be in the lungs, by external air, as an egg by heat, it only 
brings it forwards but does not produce it. The reasons for supposing 
the blood to be alive ar1st It is in perfect harmony with 
the solids, when both are in health. 2dly all diseases of the solids affect
it, as also all its spontaneous changes when out of the body.
2ly when at rest it changes into a solid, & more particularly when under 
certain circumstances, when circulating it never becomes solid, & 
this does not proceed from velocity, as it is sometimes at stagnation
but the stimulus of imperfection is not given
The coagulation of blood is the way solids are formed,
it is a natural action & throws great light upon the subject.
4thly The power of coagulation is increased when it is out of the body
5ly In all inflammatory dispositions of the solids, the blood has an  



5
[illegible] disposition to separate into its different parts; in fever
this is universal, & in local inflammations is partial, as in local
inflammation union so soon takes place. 6ly In diseases when the
solids have no powers (as in putrid Fevers) the blood also has no power 
to coagulate. The blood has not sensation, but it is not fixed but
always moving. the changes produced in the blood are from irritability 
in the blood itself & not spontaneous
Lecture 3d
As all our knowledge of an animal body is with a view to 
understand the perversion of these principles, it makes it a matter of
serious concern to know whether our hypothesis is true or false; former
theories were too mechanical & Chymical to be just, & life was never
thought of. I lay it down as a rule that life alone can be the first
cause of any effect in the machine.  The definition of fermentation 
is so extensive that an ingenious brain may resolve every thing in the
animal machine by fermentation, but it is not the same process.
Mechanics are necessary in the machine for motion and
phisiologists have laid too great a stress on it. The living principle 
is evidently different but from chymistry & mechanics.
In describing particular diseases we shall be very accurate in 
our distinctions when life acts, & where other principles are called in.
The properties of all matter must be in one of two states (viz)
perfection or imperfection, health or disease. Health in all matter is 
the study of the Philosopher. Disease is the study of Physician & Surgeon


6
Before we treat of disease, it will be necessary to understand health 
& its operations, & also when laboring under a disease. The healthy
state belongs to the anatomist & physiologists, the diseased state with the
operation of restoration, to the physician & Surgeon.
Health is a disposition to act properly according to the combined
laws of the machine which may be universal or partial
Disease is a disposition to act improperly (not the action) and 
may likewise be universal or partial or both. Universal as in all 
infectious Fevers, these belong to the Physician.
Local disease is seldom found alone (but from the universal
consent of the whole) the body more or less sympathises 
with it. Sympathy is either universal or partial (viz) 
Universal as in sympathetic Fever. Partial as the stomach being
affected in diseases of the Testicles.
The greater the mischief done, the greater the Sympathy &
also greater from some parts being injured than from others. The
body is more adapted to sympathise at sometimes than at others, & parts
sympathise more readily with some part than they do with the 
whole, or with other parts. Universal sympathy may be either immediate
or secondary, either sympathising from the disease itself, or from 
a sympathy of the disease. Sympathy when the cause is known, is
the object of medical surgery, when unknown of Physic
Physic & Surgery are distinct, but in many cases the 


7
Knowledge of both is absolutely necessary. Those mixed cases
are either constitutional complaints producing local ones, or local
producing constitutional. We have also constitutional Complaints
curing local ones, & local curing constitutional. From whence
issues, setons etc. are introduced, but they are of no service, as they 
cannot affect the constitution in a contrary way to the disease.
Constitutional complaints also often wear themselves out
The cure of constitutional complaints producing local ones, will 
depend chiefly upon the Physician. But where incurable parts are
affected which can reflect on the constitution & retard its cure,
surgery must then do all to lessen its powers, tho’ it will have but
little effect. The cure of local complaints producing constitutional 
ones, will depend more upon the Surgeon than the last, but the treatment
of the constitution will have much more effect here, than the treatment of the local complaints
in the last. The diseases which are truly Surgical, & those
which are mixed, will be the object of these Lectures.
Introduction to Inflammation Lecture 4th
Inflammation is the first principle of Surgery. It is meant
to consider some of its causes & effects. The end proposed by nature in 
producing it,  the use it can be applied to in Surgery
Suppuration I call it suppuration from the discharge being its greatest
characteristic. Suppuration is preceded by the adhesive or uniting inflamn
which is an [ex??ding] of the coagulable lymph, but so changed by the inflamd
part as to coagulate immediately upon its leaving the vessels. The use 
of 


8
of this inflammation is to set bounds to itself, & more particularly
to the suppurative. The suppurative takes place in consequence
of the adhesive not succeeding, or the nature of the parts not having
admitted it, the immediate effects is, production of matter, which 
seems to be a leading step to granulation, or restoration of parts,
by the second method.
The Ulcerative is the consequence of the Suppurative
& brings the matter or extraneous body to the surface, by absorbing
all the intervening parts.
These Inflammations can arise from three causes (viz)
from accident, from a particular disposition of the part, & from the
constitution affecting some particular part.
Obstruction of the blood’s motion is supposed to be a great cause 
of Inflammation. This notion is too confined, but any thing that will
Stimulate will produce it. These Inflammations are an attempt
towards restoration, & are proofs of health, & this proof of health
keeps up even in many Specific diseases, as healthy smallpox, which
when not in health is attended with the Erysipelatous.
Some Constitution shave a disposition to fall into Specific
Inflammation from any accident, & from accidents in particular parts
to particular specific diseases, & then an which alters both
the parts & constitution, as the Plague. 



9
These Inflammations may be produced either by simple or specific
irritations, & the Inflammation will always be according to the constitution,
& when of specific disease, the specific only superadded. From which
we are led to the treatment of specific diseases. For we are always to treat
the patient according to the Inflammation, & we have a specific [illegible]
the specific is to be superadded. All parts of the body do not admit of
all the three Inflammations, nor all of the same. External parts fall 
readily into the Suppurative; Internal (& more especially vital parts)
more readily admit the adhesive. the reason we do not know, but the
good effects of it are obvious. All the three Inflammations are admitted
only in certain parts (viz) the adhesive in circumscribed Cavities, as
Cellular membrane etc. Suppurative without adhesive, in all outlets of the
organs of sensation & of course without ulceration, as there is no confined
matter, ulceration however sometimes takes place, but it would seem 
to be from absolute weakness.
An irritation produces adhesive inflammation first,
if not sufficient, it produces suppurative, the ulcerative to let the
matter out, & lastly granulation. If the adhesive from the nature
of the part is excluded, then the suppurative only takes place.
Lecture 5th
Strength & health of constitution admit easily of resolution & 
make inflman quicker in its progress & termination. Weakness
of the constitution makes it slower, & often hardly take place. The 
blood 


10
blood also being weakened the parts hardly unite & often wven do 
not inflame, & when they attempt it, the animal powers seem 
destroyed & mortification ensues.
The effects of Inflammation upon the constitution are 
according to the kind of Inflammation & the stage of it, the nature
of the parts, & situation of similar parts. Those constitutions & parts
which are able with ease to perform all their operations, & where 
sympathy hardly takes place, seem least affected by this Inflamn.
The effects produced, are according to its violence & rapidity, not
the cause. If the vital parts are affected, the effects are much more
violent. if the heart or lungs, the pulse is quicker & lower, bleed
If the stomach, then simple life seems affected, & there is a 
depression, pulse low & quick. If the Uterus, the pulse is very quick
& low, the stomach sympathises with the uterus & intestines, so
as to produce or increase its own symptoms. When inflammation
of vital parts proves fatal, the effects upon the constitution are very 
quick, & the first stage has the same effects, as the second stage of fatal inflamn upon
any other parts. If of a part not vital, the pulse is fuller & stronger
the person is roused & the pin more intense, & goes farther to produce the
same effects. When parts are far from the source of Circulation, they 
are not so easily cured as when they are near, & when those parts
are affected which are supplied with nerves from the paroxysm &
intercostals, they always depress, whilst others rouse
Adhesive Inflammation rouses the patient. The Suppurative


11
is attended with rigors, & exacerbations. The Ulcerative is not felt in
the constitution. The blood is affected & very probably the affection of the
blood produces that of the Constitution. The disposition to Inflammation 
in the blood, seems to arise, either from an increase of the living powers,
or a greater affection of it 
Lecture 6th
Inflammation begins at a point & spreads according to 
the nature of the Constitution & parts, & is lost in the surrounding parts,
& if the surrounding parts sympathise but little its progress is very small
The swelling of Inflamed parts arises from some coagulable lymph
& serum being extravasated, 7 the swelling spreads according to the Inflammn
the serum goes beyond the coagulable lymph, & if there is a depending
part, all gravitates there. The colour of the Inflamed parts is changed to a
pale red, from the vessels being distended, & the red blood going farther than 
usual; as also the blood seeming to undergo no change from the Arteries
to the Veins, which makes the blood of a scarlet colour. The Inflamed parts
seem hotter, but whether they are really so, is not as yet ascertained.
These local effects depend also on the constitution, situation, 
parts, etc. as all other symptoms of Inflammation do.
Pain seems to arise from an alteration being produced in the
parts in a given time, neither too quick nor too slow, for sensation.
The pain from the adhesive stage is a heavy one. From 
the Suppurative more acute, and the nerves of the part become more
sensible as in the systole of the vessels, which would show, that they do 
not contract violently, as muscles impart pain in contraction.


12
Inflammation may subside before adhesion, & also after the adhesive
stage has taken place, which is called resolution.
Why an inflammation should subside is not easily conceived, it 
might become easy indeed by habit, but that it should return
back, we must suppose inflammatn an uneasy state, & then 
whenever the cause was gone, it returned to the most easy part
again
Lecture 7
Adhesive Inflammation.
Adhesive inflammation is the same whatever be the cause. When 
from the constitution it is the termination of an universal disease,
into a local one. When from a disposition in a part, if it is of
the cellular membrane, it will prove salutary.
Adhesive inflammation is not only [preparative] to the suppurative,
but is often essentially necessary for the reunion of parts in 
simple fractures, Bruises etc. The adhesive inflammation is a
disposing of the vessels for the extravasation of coagulable lymph
& serum to unite the parts together. The parts inflamed become
more vascular, which gives greater power & serves as a basis for
granulations. Extravasation also takes place, which makes the 
parts swell. The pain is not acute but very trifling & will
be increased by the quickness of it. The effects of the adhesive 
inflammn on the constitution are very trifling, & alto it
arises from a disease, yet it is a salutary process, confining 
the suppurative & always going before it, its use is shown
by 


13
by seeing the bad effects of the erysipelatous, which is just suppuration
without adhesion
Union by the first intention can only take place, either 
internally, or externally; it is formed by the extravasation of blood, whilst
the adhesive is only an extravasation of lymph; & in wounds, first the
blood is extravasated, if that does not succeed, then the lymph is extravasated
& if that does not succeed, suppuration takes place. But sometimes the 
violence may be so great as to destroy the living principle of the blood,
& then that blood is either absorbed or produces suppuration.
Living bodys have a perfect affinity, not only whilst under 
certain circumstances, but a body having life does not produce the 
extraneous stimulus, & never goes farther than the adhesive inflammn.
It is upon this principle of union sutures were invented, & the
success of the [illegible] life depends upon this, but it would be improper 
to suture gun shot wounds, or where there are extraneous bodies.
Cure of Adhesive Inflammation Lecture 8th
As adhesive inflammation is the most simple disease
(being simple action of the parts) entirely free from all specific tendency
the cure also must be very trifling & lays the foundation for the general
plan in all inflammations, very few being free from some disease & the
specific remedy may be added. Resolution is to be attempted in the adhesive
state, & only when it takes place from the constitution or a disposition in a
part, yet sometimes it may take place from accident, but not where
there is exposure


14
If the inflammation is the true healthy adhesive one,
up? we should only lessen everything that keeps the inflammation,
& as the powers are increased or more exerted, they should be
diminished, either by soothing or else by absolutely weakening
absolute weakening will strike at the cause; soothing will 
strike at the effect & will assist, as the effect may remain, 
tho’ the cause be gone.
Bleeding will become necessary according
to the symptoms. In violent inflammation, topical inflammn,
topical bleeding will answer both. If the inflammation be of a
vital part, bleeding will be of great use. Bleeding should be
used with caution, & only to ease the constitution, for too 
much bleeding will bring on an irritable habit, or increase 
the disease, & weaken the powers. The good effects of bleeding
do not seem to be accounted for upon any other principle than
the following (viz) probably in health the fluids from their
connection with the solids should be in large quantities, but 
in inflammation the proportion does not correspond, & 
therefore producing the equilibrium will so far cure the patient.
Whether bleeding from particular parts does good or not it
is not ascertained.
Medicines producing sickness lessen the powers 
of life, all the powers sympathising with the stomach.


15
Purges also weaken, the cautions in this should be the same as in 
bleeding. In irritable habits bleeding should not lower the constitution,
& bark should be given to restore the health The same practice will be
necessary when suppuration is to follow, as the inflammation must
subside before a kind suppuration can take place. Where the
constitution has sympathised much, sudorifics may be given, which 
endeavour to keep up universal harmony.
Local Applications.
We are not so clear in the effect of those which have 
been recommended. Local applications must act in three ways,
Locally, Sympathetically, & by derivation. Locally either by simple
curing, or by producing a contrary stimulus, but this last takes 
place in some only & not in all, both of these may drive the disease 
back into the constitution, & come upon the part next in order.
The local application can only be to external surfaces & 
even there some parts must be affected by sympathy. The 
sympathetic applications should be applied to the nearest surface.
Whether derivation takes place is not certainly known,
but it seems to do so. Derivation is a stimulus in one part
curing one in an other part, so that the same quantity exists
but the artificial one is more in our power than the original one.


16
Lecture, 9th
The question is, whether the counter stimulus
may or may not be performed. In all accidents there can be no objection
to it. When from the constitution it is a deposit, & will return upon 
it, it will be better to encourage its stay, but then it needs 
not suppurate, for suppuration is in one part of the disease only
an effect. Those applications which produce counter stimulus
have greater effects than any soothing applications, & the effect
is greater when applied to the part itself, than when to the nearest
surface. The remedies which act by sympathy are less efficacious.
When we have no species, the effects produced by repulsion are
considerable, which is only from the connection one part has with 
the other. In repelling, powers of medicine being so uncertain’
Surgeons have been led into great errors by them, as for instance,
they were afraid, without them of a clap turning to a pox.
The common applications are fomentations, which 
are simple or medicated & give [illegible] at the time, & of a stimulating kind
they may do good. [Washes], which are fluid applications,
are only substitutes for Poultices, & of short duration. Fumigations
are more efficacious than the same medicines given in substance.
Poultices are simple or medicated & are the best application
to keep the parts easy.


17
Plasters are used only in indolent tumours, of these hereafter
Suppurative Inflammation
Whatever is the cause which produces irritation for
suppuration, it is always the same. One great cause is violence, by 
which the parts are prevented from union, or violence with death 
in the parts, in which case ulceration & suppuration go on at the 
same time. It by no means arises from air being admitted. As
when it proceeds from violence, it is an attempt towards reunion.
In spontaneous inflammations it would seem to arise
from a disposition without destruction of parts, & of course arises
from various hidden causes. Suppurative inflammation is
violent, in short whatever produces so great a change must be 
violent.
Lecture, 10th
Symptoms of Suppuration
The sensation arising from suppuration
gives the idea of simple pain, it is known by this sensation, afterwards
by the parts beginning to swell, & the pain increasing. The
pain is increased on the dilatation of the arteries making the part throb 
this is one of the best characteristics. The redness is increased to the true
arterial colour, (which is a constant symptom) by the formation of new
vessels, & the dilatation of old ones, which is now greater than in the adhesive.
The parts are also more swelled, in the adhesive inflammation, & the
surrounding parts become edematous. Some parts of the inflammation 
also lose the power of resolution by the adhesive & suppurative, the
vessels


18
vessels gradually change from throwing out coagulating lymph,
to throwing out Pus, & the earlier abscesses are opened the more of the
former is found in them
The effect of inflammation is to produce the suppurative
disposition, in doing which it seems to destroy the condition of the
parts on which it depends, & then it ceases, & suppuration takes place,
& granulations cease untill it goes off, which shows them to be very 
different. At the point where suppuration takes place new symptoms
appear as Rigors etc. but the effects on the parts require some time
to form the vessels for suppuration.
Treatment of Suppuration
If suppuration could be stopped it would be proper
to do it; we have shown that the adhesive may resolve & the suppurative
may stop without granulations, or even returning to the adhesive, as 
in some cases of empyema. If we could increase our power of stopping
suppuration it would be an useful discovery, as suppuration often
proves fatal. When suppuration cannot be stopped it should be 
hurried, & it is attended by ulceration, how far medicines hasten it
& do not know, in indolent cases it may rouse the constitution
& by this means hasten it, but not the true suppuration. Medicines
hasten ulceration & that was mistaken for hastening suppuration.
Poultices are used to keep the parts easy, & when ulceration
is near the skin they soften it, & make the parts more easy.


19
Pus Lecture 11th
The  discharge is at first merely coagulating lymph
& serum, but as this inflammn goes off some change takes place in the
vessels & it becomes thicker & thicker, untill it is perfect pus. This discharge
pushes off the coagulable lymph from the inflamed surface, so that abscesses
contain both. Pus is not to be found in the blood, but is an operation of a
certain structure of vessels, or a gland, & is a secretion. Extraneous bodies in
the blood, & dead parts, do not enter into the composition of pus. Pus is compounded
of a number of white globules swimming in serum, & some
coagulable lymph, & the globules are in proportion to the health of the part.
The quality of Pus is according to the nature of the parts, & if they
have specific qualities, it has them also.
Pus is always in perfect harmony with the part producing
it but may be mixed with extraneous bodies (as salts) which 
may stimulate.
When the parts are diseased the pus is much
thinner & has more the nature of the blood, & more extraneous substances
mixed with it, & therefore is more irritating but not corroding.
But matter may arise from the certain structure not being
perfect; & granulations seem to depend on this, as they are in these cases
bad also; what structure or organization this may be is not at all known.
True pus is perfectly sweet & has a power of resisting
putrefaction more than the natural juices, it becomes putrid from 
situation, or from substances mixed with it. Pus that is not perfect
becomes 


20
becomes sooner putrid, as in most specific diseases. Many 
conjectures are given at the final cause, but I believe we are not at all
acquainted with it, we see in healthy sores it takes place in the most
perfect degree, & parts not essential to life may have a great discharge
& yet may be heated up & do well.
Ulceration Lecture, 12th
We may consider the animal machine as an
hydraulic one. The tubes are of two kinds, the arteries which build
that? up & repair losses, & separate particular parts in the
different secretions. The veins were supposed to bring the blood back
again, & also sometimes to open on surfaces & bring in nourishment,
The lacteals destroyed this last in part, & the Lymphatics entirely 
overturned it, & made the veins merely passive
The absorbent system does more than simply absorb
nourishment; it counteracts the arteries in many of their operations,
& models the machine. The use of the absorbents may be divided into
two classes, [absorbing] parts which are, & which are not, part of the
machine. Of those parts, which are parts of the body, we may divide
into three (viz) that which models the body whilst growing, wasting
of the whole or part, & absorption of complete parts, which last is
what I mean to treat of & call ulceration.
Ulceration is the same whatever be the cause, all parts are 
subject to it, & whenever any solid part of our body is diminished



21
by disease, it is the cause of it. Ulceration must arise from a stimulus
& may be either with or without suppuration. The first Species is [flow]
attended with no pain & no inflammation, it may be divided into two, 
when produced from living bodies, or dead ones (which do not stimulate) producing
it, & when from debility. Of the first we have instances in Aneurisms,
living tumours etc.
Lecture, 13th
Every extraneous body that has the power of 
stimulating whether internal or external can produce ulceration
This process is only attended with the adhesive inflammation
which answers several purposes, it is generally attended with pain
& soreness, if not always (as in scrophula) & in abscesses would seem to 
arise from all the processes together. Cellular & adipose membranes
are most susceptible of this process. It is very curious that the parts
only which are next the skin take on this disposition; distension
could never effect it, as the parts would thicken in proportion.
The case of the intestines illustrate this, first adhesion
takes place, then suppuration in the middle, then ulceration preceded 
by adhesion, & open’d externally; deep seated abscesses often
ulcerate in all directions. Abscesses in the lungs often open in 
he air cells, as an external surface. Ulceration is only an 
operation to remove parts out of the way of pressure, & may go
on after an abscess is opened, but granulation tho’ pressed does not
ulcerate.
The ulcerative process has no power over the cuticle



22
hence the pain in whitlows; they should be poulticed & 
opened early, & if any parts protrude they should not be cut,
but simply poulticed till they subside.
Ulceration also takes place without any apparent
cause, but from debility, & perhaps the sense of weakness may become
a cause. Parts ulcerating so readily, also suppurate, and the 
adhesive inflammation preceeds it.
An ulcerating sore is made up of hollows, the skin
is notched, thin & turned in, when stopped the edges
of the skin are regular, smooth & turned in, & is of a purple colour
covered with semitransparent white.
Granulation Lecture 14th
All surfaces suppurating, have their basis in 
the adhesive state, near suppuration, & are more vascular, which 
serves as a basis for granulation. No surface will granulate untill 
exposed. All exposed parts which suppurate never granulate
Where granulations take place they go hand in hand
with, & follow suppuration. Suppuration seems necessary to dispose
the vessels for granulations.
Granulations are coagulable lymph,
with the old vessels shooting into it, & enter new ones set up.
Granulations secrete pus, so that vessels seem to 


23
be changed, granulations always partake of the nature of the part
the surfaces of granulations are made up of eminences, & are healthy
in proportion to the smallness of them.
Granulations are of a florid red colour, when they 
are unhealthy they are livid, but this may proceed from the position
of the body. The stagnation of blood will change its colour
Granulations are nearly as high as the surrounding skin,
& when healthy have a disposition to unite, & they serve as a basis for
the skin. Granulations may unite from the secreting vessels of one 
part opening into those of another, & the stimulus of action takes place,
& a kind of sympathetic action is produced. Unsound granulations
are smooth, & secrete a sort of bad thin matter, & have no disposition to 
unite.
Granulations show how far the constitution is affected by 
certain diseases, as Fevers etc. IN small wounds where the blood or 
matter forms a scab on it, cicatrization may take place without
granulation.
Granulations contrast & draw the skin untill they 
are quite skinned over, & contract in proportion to the health.
The granulations after the whole is healed continue
to contract untill no more is left than what new skin stands up, & 
that becomes ligamentous.



24
Lecture 15th
The inflammation attendant on Fevers,
going off of these, & commencement & continuance of suppuration,
often produces a change in the constitution making it nervous
hectic etc. & this disposition is increased by continuance of suppuration.
Locked Jaw, Hysterics etc. often are the consequences of those
leading causes. Those bad effects have been laid to absorption, tho’
not justly, first because it attends inflammation of many vital
parts, & joints before suppuration has come on, secondly all 
large sores should be attended by them, for one sore should absorb as
well as an other. Venereal sores & abscesses in veins should produce
the same effects but this is not the case.
This hectic disposition never comes on untill
abscesses are opened, & it is not in the power of nature to heal them,
it would seem to depend on the cause of irritation being out of 
her powers
Skinning over something like crystallization requires 
a surface to shoot from, which is the surrounding skin, whatever
change the granulations undergo in forming skin, they seem
guided by the surrounding old skin, but when the old skin can
not give the disposition, the circumference of the sore forms
a circle of skin, from which the rest shoots, skinning is always as 
aparing as possible, the contractile power of the granulations always 


25
assisting it. Contractile power may be assisted by art but not untill
granulations are formed. There is also a contractile power in the cicatrizing
edge of the skin which assists.
Whether contraction of Granulations depends on approximation or
absorption is not easily determined. The new skin is not so elastic & 
moveable as the old, but this goes off in some measure by motion, by the
adventitious substance consequent on inflammation being absorbed.
Mercury has this power.
The new skin is thin & smooth & without indentations,
as is evident from the cuticle being a little larger than the skin.
New skin is not near so durable as old; the young cutis is full o f
vessels, these disappear & the skin & granulations beneath become white.
The cuticle is easily formed, as every point of the 
cutis forms cuticle for itself. The old skin is all thrown into folds,
& the new skin is stretched. The [illegible] is later in forming
& sometimes is never formed.
The Application of the foregoing remarks to 
practice.
Lecture,, 16th
Simple fractures are healed by the first intention,
but are attended by the adhesive inflammation in those parts where
the blood could not enter. The coagulum becomes vascular, at least
becomes very similar to the surrounding parts. 


26
Compound fractures are where the blood escapes. The suppurative
inflammation comes on the cavity & it heals by Granulations 
which granulations are afterwards changed into bone
Simple compound fractures, are where the blood in a 
simple fracture has become dead, & is driven out, & so makes
a compound fracture, but it is in general less dangerous, part of 
the blood returning to life.
Compound simple fracture is also where the 
orifice of a compound fracture is closed & healed as a simple fracture,
& will heal such, only there will be a little sore on the old opening.
Empyema is also attended by suppuration which 
either leaves off at once or heals by granulations.
Emphysema, 
we should avoid this operation as it would bring on inflammn
The wound in the lungs will soon heal, as being as it were
external, & the air may be let out of the cellular membrane by 
small incisions.
After tapping, the suppurative inflammation
often extends over the whole peritonaeum.
After the operation for the Hernia the suppurative
inflammation is excluded by the sides of the [sac] at the abdomen,
uniting by the adhesive inflammn
The bladder does not take on the suppurative


27
inflammation on being exposed.
Opening into the joints is dangerous on account of
the suppurative inflammation which must destroy the
joint by granulation, but it seldom goes thro’ the stages quickly, & the parts
die, slough, & produce very bad consequences. When opened they should be 
brought together by bandages to unite by the first intention. Sacculi
Mucori may be opened & will suppurate & heal like a common abscess
Lecture,, 17th
The suppurative inflammation often comes
on after performing the operation for extracting the crystalline humor,
the wound of the cornea not healing by the first intention. It will also 
come on after any opening of the eye which does not heal, & the eye will 
suppurate & granulate & be so obliterated.
Whether the brain suppurates from exposure is not
easily determined, but we should suppose it does, as the Dura Mater does,
& the brain itself swells, or takes on the adhesive stage, but perhaps
the injury will kill before suppuration takes place.
The inner surface of veins take on the suppurative
inflammation, & where this happens we should always have abscesses
but that there is such an easy passage for the matter, upon this
principle the bad [arms] after bleeding, the external wound first
festers or ulcerates, & then the vein inflames both up & down


28
& form abscesses, & these always in direction to the heart, & the
vein is obliterated at that part (this frequently happens after
bleeding horses, & the whole jugular vein will inflame)
Whether when this proves fatal, the patient dies from the 
inflammation extending to the heart, or from the matter getting
into the circulation I do not know. I am inclined to believe that
the extensive inflammn in many wounds arises from the exposure
of the surface of large veins, & perhaps the reason why they extend 
at all beyond the surface is sympathy
In the puerperal inflammation, the suppurative
inflammation attacks the whole surface of the peritoneum 
some days after the child bed, from the [stimulus] being gone, as if the
whole uterus was entirely removed. It may perhaps be assisted
by the evacuation being so sudden while the distension was 
gradual. It may be confined by the adhesive inflammation
to parts of the cavity & form abscesses
Hydrocele, Lecture 18th
The palliative cure may be performed with 
a common lancet, & the wound no larger than in common bleeding,
or by a small trochar.
The radical cure must be either by the adhesive or 


29
suppurative inflammation. By the adhesive, when the whole surface of the 
sac is united by the adhesive inflammation, by which means the cavity 
is obliterated, but we have no power of producing this, & perhaps it is not
possible ever to acquire a means of producing only adhesive inflammation 
without the suppurative also, but I once saw a case of the kind happen from 
accident.
The different methods of Radical Cure.
The sac may suppurate & open like an abscess, & 
heal by granulations; this case may deceive the Surgeon & make him
suppose it to be the Testicle, unless by opening the abscess he sees the Testicle
at the bottom, yet even then he may suppose it to be diseased from being
so much swelled, & the pain of the whole being that of the Testicle, yet
the case is not attended with pain in the small of the back, & such a 
dull heavy pain, this should be attended to. In such cases where the 
water is in hydatids it will be more likely to deceive him.
A [tent], stimulating liquor, a seton, & Caustic,
are all in use, & reckoned to cure by adhesion, but the caustic was
said to make the whole Tunica Vaginalis slough out. They certainly 
only produce suppuration by keeping the orifice from closing, & perhaps
liquors thrown in may hurry suppuration by their stimulating 
powers. Surgeons have even gone so far as to dissect off the Tunica Vaginalis
itself, but this is never necessary, unless the parts are so diseased as to 


30
require extirpations in the Radical Cure may likewise be
effected by Incision & afterwards the pts being brought into apposition 
will unite by the first intention or adhesive inflamn
The disease is a collection of Water in the Scrotum & 
Spermatic Cord; The great object is, to know the situation of the Water.
This disease imitated by a diseased Testicle, but may be
often distinguished from it by its shape; The Hydrocele being in 
general Pyramidal, whilst the diseased Testicle has its sides flattened.
The situation of the water is to be known by the following
means; if it is in the Tunica Vaginalis, it is generally behind 
if no previous adhesions have taken place. If the water is in an Hydatic,
the Testicle may be anywhere, but in this last case the Tumour 
is more rounded. 
In performing the operation the Testicle is to be 
carefully avoided, altho’ it has been wounded without any mischief
ensuing.,
Lecture 19th
The best guide to know the situation of the Testicle
are? the feelings of the Patient. The opening should be made about the
middle, for if it is made low down it will be in the middle of the swelling,
& so be choaked up, & if it is made at the top, the sac collapsing will 
carry the internal orifice out of its place.
The water should not be entirely evacuated, as it
makes suppuration more general & prevents the sides of the 



31
sac from adhering together. If the caustic was not uncertain in its
operation it would be the best, as it makes a freer opening, & the adhesive
inflammation determines the thickness of the edges of the wound before the
general inflammation comes on, & the general inflammation also comes
on before the water is evacuated. A Cloth with brady & a suspensory
should be applied to the Seton.
When the Testicle swells there is a [illegible] heavy 
pain & & a pain in the back. These symptoms will come on in
less than 24 hours, at first there are small rigors, restlessness, Thirst etc. The
scrotum swells considerably & becomes very painful. The Testicle also
swells.  the wound becomes very deep from the skin to the sac, which is 
corrugated together in a small compass, & heals by granulations.
Lecture, 20th
The parts which have the strongest disposition to heal, 
are the cellular & adipose membranes, & this will be greater if near the source
of circulation, & in certain neighbourhoods, for the neighbouring parts not
only influence the cellular membrane, but generally take part in the
disease. Muscles heal very readily. The parts which have a backwardness
to heal are Tendons, Bones, Periosteum etc. these are indolent, & under
a disease they often lose the power of action & even life itself. These
parts are naturally different in their sensations from other parts, & are
so likewise in disease & the pain is a heavy sickly one as in the pain 


32
in the Tendo Achillis when pinched.
Sound abscesses are where the constitution is sound, 
the parts having all the powers & disposition to heal, & of no incurable
specific kind. The inflammation is healthy, violent & gives great
pain, ulceration is rapid, & the skin is florid & soon bursts.
Poultices may be applied as they keep the skin soft & moist. & 
are? warmth & moisture sedativ to secretion. When perfectly sound
nature will perform a cure, but freedom of opening makes the parts
endeavour to heal sooner, as the action in sound parts is in proportion 
to the mischief.
If the nature of the parts prevents its openg
freely, the opening should be made in a dependent part, as the pressure
of matter may bring it to the skin at another part or prevent the
growth of granulations or retard their progress, & this would be greater 
at the depending part, & the upper part healing would reduce it to a 
Fistula. Nature will often perform a cure, tho’ sometimes when 
sound to all appearances at first, they will become indolent & 
irritable & must be treated accordingly. By their situations 
abscesses are retarded in their cure, when deep seated they are less
uneasy under disease & have a great way to come. & ulcerating sound
parts which sooner heal than the seat of the disease which often
becomes Fistulous. There should be freely opened, & invigorating applicatkons
applied to the bottom, care being taken to keep the superficial


33
parts from healing. Abscesses are retarded in their cure by the nature of the
parts, these parts should not be roused but treated with mildness as it proceeds 
from want of powers not of disposition to heal.
Lecture 21st
Unsound abscesses may arise from diseased constitution,
unsound disposition of the part, nature of the parts, situation, slow continued
stimulus, & from cold. As they have little or no disposition to heal, they do not 
inflame, suppurate ulcerate & granulate with rapidity.
The method of treatment must be to produce a sound
disposition or an artificial, or temporary one. When it is indolent the pain
is very trifling, the colour of a pale purple & slow in its progress. If it be
merely local, it is more circumscribed than if it is constitutional, but  it is not 
always so. Indolence from mechanical pressure, is the parts thickening according
to the pressure applied, & exactly contrary to the ulceration from pressure,
and this arises from the pressure being in one case too great, & the other
from nature having time to assist the parts. The cure is by taking off
the pressure & counteracting its effects by rousing the parts, this is effected
by Mercury. Cold is not probably an obstruction of the animal powers
which are used to produce heat, this will be according to Colour or constitution
The cure is warmth, with warm medicines, Poultices with mustard etc.
The diffused is generally from constitution but it may 
also arise from a disposition in the parts, they first swell, give little 
or 


34
or no pain, become hard & are attended by heavy pain, suppurate
seemingly for want of powers, & there is a glasy fluid only, contain’d
in them. The cure is performed by resolving them if possible, & 
bringing on an healthy inflammn which changes the disease, but
if the inflammation is too violent or mortification comes on. Inflam 
lays the ground work for the cure, & the parts may resolve, or 
suppurate & heal & the thickening substance is absorbed.
The Cancer & Scrophula cannot be healed by 
these mans; resolution should be tried early, first by increasing
the power without inflammn as by Mercury, secondly by 
inflammn as Poultices of Mustard Horse Radish etc.
If too far gone for resolution, still more stimulating Medicines should
be applied for suppuration, & ulceration should also be hurried on.
It should not be opened early, when it is let it be done freely
follow all the [sin???es], & stimulate as much as possible. Balsams
are of service & more so when mixed with red precipitate etc. Tincture
of Myrrh, Bark, Lunar Caustic etc. should be applied often, & varied
if one should not succeed.
Lecture 22d
The diffused in general are less indolent than the circumscribed.
The circumscribed generally begin in a distinct part, mostly 
in Lymphatic Glands, & swell considerably without affecting the
surrounding parts. They sometimes suppurate when they are small 


35
but often not till they are very large, seemingly accidental, I separate as much as
the diffused, & there is rather less of true suppuration. The matter contained in 
them is of two kinds (viz) The first is when the substance of parts becoming 
schirrous & broke down into a curdy substance with no distinct coat formed,
as in many Lymphatic Glands. the second is when parts retain life 
& swell becoming solid through & through with serum in the middle, when 
they inflame it is very diffused. There are such in the necks of Women.
Taking out the substance of the first will be sufficient, but extirpation
is necessary in the last, but as it can’t be ascertained before hand extirpation
becomes advisable in both cases.
The irritable is a disposition which is too 
much affected by a disease to set about a cure, & belongs both to the [nerves]
& living principle. It is in general constitutional tho’ sometimes local 
It inflames but is that species of inflammation which has no 
crisis, & is often attended with erysipelatous. The extravasation is very 
watery & they are very much circumscribed, tho’ often only to be distind
from common inflammation by the effects of applications.
The mode of treatment is to avoid irritating & to soothe
the part resolution should be promoted as suppuration requires more
exertion. Caustics will answer best in opening, as they stimulate less 
than the Knife.
Opium is the best application in all its stages & 
the Bark internally.


36
Fistula are always in consequence of, or intended for the
passage of some fluid. These are either artificial passages for a natural 
excretion, or a diseased passage for the secretion of disease. The first 
arise from obstructions of the natural passages, & a disposition 
in the new one to heal. The second is a disproportion in the disposition
for healing, between the seat of the disease & the opening
in the skin. This we see in large abscesses unfavourably opened,
the matter preventing the abscess from healing, & indolent parts 
being diseased, or a disease in any part surrounded by sound 
parts. The passages seldom or never heal up entirely which 
is worthy of observation, & this would seem to depend upon sympathy. 
Method of Cure
Those from obstruction will generally do
well that being removed, those from pressure will generally do 
well by opening the abscess more favourably.
In those proceeding from disease exposure 
is proper, but they are generally unmanageable.
Fistula Lachrimale take place from an obstruction 
in the passage to the Nose; The sac swells and bursts, & the matter & 
tears are discharged by the wound, until a new one is made, if the
parts are not too much diseasedS



37
Fistula from wounds in the parotid duct can only be cured by 
making another more favourable Fistula.
Fistula in consequence of abscesses in the Lungs
Liver etc. can only have external openings kept as open as much as possible.
Fistula in Joints if they cannot be removed are the same.
Fistula in Ano at the beginning are only 
abscesses, which can only be cured by being thoroughly laid open,
& this can only be done by slitting the gut
Diseases of Bones, Lecture, 23d
The diseases of Bones are the same as of other 
parts, but as there are differences from the structure, they must so far be 
considered apart. Bones are more tedious under a disease than soft
parts, but perhaps this may arise from our ignorance of the management 
of the disease, not knowing its extent & nature so well as we do
the soft parts. Hard Bones exfoliate sooner than soft ones. Bones
simply exposed generally exfoliate because they are simply 
nourished from the Periosteum & the living parts are very susceptible
of ulceration.
Bones exfoliate simply from being deprived of’
their Periosteum, & more so if the Bone is hard, but a Cure in 
a soft bone generally stands longest.


38
Diseases from Accident
Bones from their solidity, may suffer much from 
accidents, such as the parts being divided, or only sufficiently so to give 
the Bone an unsound disposition, this will depend upon the 
constitution & situation of parts & they also take on specific dispositions
of Scrophula etc. if the part exfoliates it will heal up kindly. If
suppuration without any other mischief it will likewise heal
kindly. Caries has been a common term for diseases in the Bones
& they were divided into moist & dry, the dry did very well, & the
moist were to be dryed.
Caries is more frequently an Ulcer & gives
no idea of the disease of Bone.
The principles of an animal machine are constantly 
the same in all their operations & in all these deviations from 
them, but there is an operation which arises out of the necessity 
as in Fractures which seems more accountable
Bones are originally formed from Cartilages or
Membranes & we find when a new bone is formed from disease,
it is formed from the same substance in which that Bone was
first formed 
Lecture 24th


39
Bones are subject to inflammn as well as soft parts which we also
term the adhesive (in ossification) suppurative & Ulcerative. The Inflamn
of a Bone is at first attended with a very violent depressing pain, sometimes 
after it swells uniformly in all its parts from extravasated coagulable lymph
& calcarious earth. The constitution is little affected, but has [illegible] 
with 
continued Pain, as the bone is tedious.
The surrounding parts also take on a disposition 
to form Bones in themselves & this happens oftner than the swelling of
Bones & therefore it would seem that it could happen from Periosteum
simply, only depending upon being near a Bone, the use of this effect 
must appear obvious (viz) uniting fractures etc. The adhesive inflamn
of Bones produces Anchyloses which are of four differend kinds
1st Anchylosis between two Bones merely from being near enough to 
be within the influence of ossific inflammn without a joint.
and
2 Between two Bones which form a joint without Capsular Ligament.
3d Joints which have a Capsula having the disposition in the Capsula,
which sometimes runs along it for its whole length, but seldom so 
far.
4th Anchylosis of Joints having Capsula by their whole surface 
of articulation, which arises either from a violent inflammation 
in their cavity, or the joints sympathising strongly with the 
surrounding inflamed parts. The cellular substance is changed 



40
to a soft substance, or entirely removed, the cavity is filled
with exuded matter & becomes bone.
Simple Fractur is just healing by the first
intention, the adhesive inflammn being only an assistant
& not essentially necessary. The vessels fill the lacerated cavity
with blood, the ends of the Bone & the soft surrounding parts
inflame, to fill up all the interstices that bound the cavity,
the parts become more vascular, & the ossific disposition from 
the situation takes place & the callus is formed
Lecture,, 25th
It happens sometimes that in the
Anchylosis by the adhesive inflammation the disposition for
ossifying does not take place. It likewise sometimes happens that’
[illegible] the soft union is wanting, as in some simple Fractures:
why this should be is hard to say, as it does not seem to depend
upon constitution, & we may remark that it seems confined to 
certain periods; for if it has not formed Bone in a certain time
it cannot do it al all. It seems impossible that no soft union 
should be formed, as the blood must be extravasated, but this may 
become dead & be absorbed



41
When neither union by soft nor bony Anchylosis takes place, the parts’
are rounded & adapted to one another by absorption. The surrounding parts
are thickened, forming a Capsula. & bloody serum, & sometimes even Synovia
is contained in it, & even cartilages have been found. In dislocations where
the head of the Bone is upon another Bone, absorption takes place & the
adhesive inflammation comes on, round which it makes a socket, this
also has a Capsula & a fluid to facilitate motion.
The intention in the Cure will be the same as in 
the soft parts, but from the structure the means must be different.
They have two modes of treatment (viz) Local & constitutional 
The local will be the least efficacious from its being seldom in our 
power to apply them on account of [situation] etc. It should be well
considered if the disease is of any specific kind & treated accordinly.
If it is only inflammation, bleeding, Fomentations,
[illegible] etc. should be used, if these do not succeed it may go on to suppuration
but often becomes indolent & remains swelled for many years. The 
adventitious Bone may always be considered as a weak part, & perhaps
only to be removed by producing great weakness. The internal
Medicines are the same as in inflammations in general, but as
they become indolent, Mercury internally & externally should be
used, not in sufficient quantity to cure a pox, or too little for an
ulceration


42
Lecture 26th
Abscesses.
Bones suppurate as well as soft parts
but much seldomer, whether this arises from structure or for 
wise purposes, is not easily determined, abscesses form in the center
of Bones, but oftener on the external surface. Suppuration is attended
by the adhesive & ulcerative inflammations as in soft parts; so
granulations rise to supply the loss & serve as a basis for cicatrization.
The situations of abscesses are threefold & those in Joints 
may be called a fourth; The first is in the surface, the Bone
inflames & gives the ossifying disposition. When it suppurates the
periosteum separates & matter is lodged between it & the Bone, The
ossifying disposition goes before the soft parts thicken, which gives
the appearance of a very much thickened Bone, The matter 
comes to the skin, ulcerates & heals, & nothing is necessary but 
opening it freely except where the skin should be saved.
The second is in the substance. The ulcerative
must attend here immediately, as no distension can take place
& only in the side next the skin where it has come to the surface
of the Bone The ossifying disposition takes place on the outside 
whilst ulceration goes on in the inside, but not so fast, therefore 
at last it bursts & forms a swelling in the soft parts. 



43
The third is when it is in the Medullary substance.
the matter produces ulceration all round,
& the ossific disposition takes place on every side so that the Bone
increases to a very great size, & often the shell is all new formed Bone,
& if one part does not accidentally ulcerate faster than another it might
never get out. These bones often break by the motion of the Body.
Lecture 27th
Treatment of External Abscesses.
As the Bone is only on one side of the abscess it is only necessary
to open freely, & keep the soft parts open untill the Bone throws out Granulations
or exfoliates, & if it will do neither the cautery must be used
Iternal Abscesses in Bone are generally a long time before
they are discovered & are to be treated as a Bone, untill an external openg
is found out, this should be opened by the Trepan, & if the parts fall
into an indolent state stimulating dressings may be made use of
Abscesses in Joints
Joints seldom suppurate as other parts do & 
are more tedious, & remain in a state between the adhesive & suppurative
inflammation so that a constant irritation is kept up. They generally 
become so indolent & diseased before they are opened, opening them
has but little effect. The constitution is more affected in diseased
Joints, than it is from diseases of Bones simply which arises from the pasts
having so little a disposition to heal & keeping up a constant irritation


44
They have hardly a disposition to granulate & remain 
Fistulous, which harasses the constitution, produces [illegible], & the
patient will die if the joint is not removed. When the parts are
sound they will heal as kindly as a common abscess. These granulations
fill up the Joint & make a soft anchylosis. They
ossify as most granulations from bone do, & form a bony anchylosis
which is generally made larger by the surrounding parts taking on
the ossific inflammation. The compound Fractures heal exactly 
in the same way, the granulations ossify & the Callus is enlarged
by the surrounding ossific inflammation. The difference between
the compound & simple Fracture, is that the compound is obliged
to granulate & fill up the whole cavity, before it is in a footing 
with the simple in its first state. The danger of a compound Fracture
arises from such a large surface taking on the suppurative inflammn
We have also in compound Fractures sometimes the bony disposition
not taking place, & even sometimes that by granulations.
Matter from Diseased Bones
Lecture 28th
Matter from a sore when there is a diseased Bone
is seldom good, because matter from a diseased part is worse
than from a wound part, & is thinner & has a greater tendency
to putrefaction. Diseased bones which are bare by mechanical 



45
effects, cause bleeding which increase the tendency to putrefaction
such matter generally tinges or party corrodes silver
New formed parts are less able to support themselves
under a disease, than original formed parts, as they are a deposit from
the system, so the system takes them up, whenever they have more to do
than they can support. Those formed by the adhesive ossifie inflammn
are taken up by the ulcerative, only as Collus in simple Fractures, the
union is by the first intention. Then formed from Granulations
are taken up by the suppurative ulceration, which 
generally begins in the new formed soft parts, which are most susceptible
of it, & proceeds to the Bone, as in Compound Fractures old sores etc. 
Those parts formed from Granulations seem to have less 
powers than those from the adhesive inflammation
Ossification and Ulceration changing the situation 
of Bone
There is a disease which becomes the cause
of ulceration of Bone, (the remote cause of which is not at all known)
It is an extravasation of blood in the cavity of the Bone which produces
ulceration & would soon come thro’, but the ossifying disposition takes
place on the outside, tho’ not so fast as the ulcerative, so that the
Bone becomes a thin shell, & then bursts, yet often it is become 
of a considerable size, & even after it has broke the extravasation of 
blood goes on. There is sometimes an accumulation of curdly 
substance 


46
substance in the Bone, which produces the same effects
I think there is something scrophulus in both these cases
but especially in the last. The cure of this disease must be
by preventing the extravasation or blood or formation of curdly
substance.
Rickets Lecture, 29th
The rickets would seem to be a general weakness
joined to a peculiar disposition in the bones
The disease is a want of disposition to form [illegible] from whence
the Bones grow longer & bend under the weight of the body. This can
only take place in young subjects as in them only there is a disposition 
to form [earth]. The same effect takes place in the adult, 
perhaps from there being a disposition to absorb the earth, & altho’ these
two ways of having the rickets are very different, yet they may arise
from the same first cause (viz) a disposition in the machine to produce
this effect
However as the calcarious earth is always changing 
the Rickets may arise from the same disposition in all Cases, only in 
the adult they can have no growth, as that operation of the Bone has
ceased.
Effects of Mechanical Pressure
Such bones are bent between and send by the action 
of the Muscles & superincumbent weight as also the Joints. 


47
As no Bone stands perpendicular 
one point pressed more than another is retarded, & so by throwing it 
straight more out of the straight line increases the power. These
effects often produce ossific inflammation, the rude naturally pressed
giving a disposition for that to strengthen it. All possible means should 
be used to strengthen, as Sea bathing, Cold Water, Exercise, Bark, Steel etc.
Exostosis, this is a disease in some measure
peculiar to youth, & perhaps proceeds from the same cause as Rickets.
It is an enlargement of the Bone in a particular part. It is sometimes 
only local or partial, & sometimes constitutional or almost universal.
They sometimes arise all at once from the Body of the Bone
to a considerable size, & swell out, only joined to the original Bone by a 
Neck which would show they have a power or growth within themselves. 
They sometimes come on gradually or by a slow degrees. Sometimes 
they are in great numbers & Vice Versa.
The Bones so affected often swell at their ends, which 
made me suppose it the same as Ricketts, only varying according to 
some circumstances unknown to us. It is the shooting out of Bone
from the original one, as in the Horns of Stags, mamillary processes 
etc.


48
Lecture 30th 
Fractured Patella
The union of the fractured Patella seems to partake
both of simple & compound Character. Where the Bones are
brought near together, I can suppose them united by the extravasated
Juices. When the Bones are apart, how they unite is not known.
I can conceive the coagulable lymph coagulating immediately
upon being thrown out also keeping the Bones without motion
of the Knee. The first soon unites; passive motion should be 
given to prevent a ridge from forming. 
The second is more tedious; & in proportion to 
the distance & disposition to unite, & then there must be strength
in this union. The Muscles adapted to their situation, acquire
the extent of this new motion, & strength in the new action.
This loss of contraction of the muscle according
to the distance has not been thought of, & also that muscles
have a power of acquiring a new action. When the Patella
is broke the extensors draw up the upper half & keep it high up,
whilst the Bones are uniting the muscles are adapting themselves
to their new distance & gradually acquire a new action. But


49
they should be encouraged in this new action by well stimulating,
which should be as often as possible, & this action is to be strengthened
by exerting it with greater assistance, So that when the Patella is
broke the parts unite & get strength in that union by [illegible]
Motion in the Joints is first to be gained by passive
motion, then by acting with the muscles, flexion will be very easy 
at first there is hardly any extension, but by continually stimulating
the Muscles by the will & exerting them constantly, the full motion 
of the Joint is to be gained, & this action strengthened by gradually 
increasing the resistance.
Bandages have been recommended but
are entirely to be neglected here, for they are only to be used when 
the parts are to acquire strength from [illegible] but here the only way of 
acquiring strength is by the action of the living principle & the 
strength will be according to the necessity. Bandages are just the 
destroyers of this action & consequently to be laid aside
Gun Shot Wounds Lecture 31st
There are wounds made by the [persection] of 
an obtuse body, which forcing its way through the solids deadens
a portion round the wound, which sloughs off & prevents the loss
of blood, which happens in wounds in gneral


50
Gun shot wounds may be considered as accidents, & degenerate
into various complaints, as all other accidents do. These wounds
will differ according to the velocity of the ball, if that be great they 
will bleed freely, velocity being equal to sharpness & the direction
will be [straight] if it be small the bleeding will be inconsiderable & 
the parts will be almost divided & the slough much smaller
They may be divided into wounds of soft parts, compounded
with fractures of Bones, penetrating cavities & dividing
arteries.
Method of Treatment.
It is a common practice to dilate gun shot
wounds, but this is opposite to all principles of surgery & should
never be done except to extract some body or to let out matter
as in common Surgery, as there is a slough to come out the
parts cannot unite & there is a free passage for the matter.
One great reason for opening is to take off union, but 
as inflammn produces this union in increase of inflammation
must augment it, in short Surgeons opened without any other reason
than because it was a Gun shot wound
If the wound is large & the inflammation considerable,
& the opening necessary (if circumstances do not contradict it)
I would wait untill the first inflammation was gone off.


51
But before opening we should consider if the good purposes exceed 
the bad consequences of the increased Circulation etc.
When the whole inflammn from the wound
can be taken off by an operation it should be done at first (if the
state of the Patient permits, if not, it should be left untill the Patient
be recovered from the effects of that inflammation.
If the Brain is injured we should trepan
as in common, or perform every operation to relieve it, not because it
was a Gun shot wound, but because the Brain was affected.
If the Bones are fractured & the pieces can be extracted
easily we should extract them, as in compound fractures. Where there
is an extraneous body which would do more harm by lying in 
than the operation of extracting it would, the operation should be 
done
If any parts are misplace they must be replaced,
as in Gastoraphia, when the Viscera of the Abdomen are pushed out
If any present good could be gained to the part or to 
the Patient we would open immediately; If no such good can be obtained
I would wait untill the inflammation was gone off & then 
pursue the cure



52
Lecture 32d
The present practice is to pay little attention to the
ball when not in a vital part, because we find they lye in the Body
for years without doing any mischief. Such Balls are always spent
ones, consequently the velocity is so small, that any resistance
changes its course, & makes it impossible to know the direction of it
in these cases the parts are only separated & collapse, which increases
the difficulty, & also the situation in which the part was when wounded
can seldom be ascertained. For these reasons Forceps are almost
useless; but still in cases where the ball can be got at it is right
to extract, but it is better to wait untill the adhesive inflammn 
has surrounded the passage, & all inflammation is gone off.
When the ball has gone in a considerable way and
passed out again, I would advise a middle opening to let out the 
matter etc. Where the ball has passed only under the skin, I would
slit it up, as the skin very slowly unites with the surrounding parts.
Where the ball has only gone under the skin as even pretty 
deep, there is often a red line which I cannot account for.
If the ball has passed thro’ to the skin & there stopped, I 
would not cut it out if the skin is not deadened, because the 
wound will heal very well with it in, & by cutting it out, it 
is similar to its passing through & both openings inflame & 
if it forms an abscess it will be easier extracted afterwards


53
When a ball pases through the inflammation is greatest at the
first orifice, as the velocity was greatest there, the depending orifice is
consequently less injured, & from the tumefaction falling upon the 
lower parts it sooner heals up, but should be kept open as long as
necessary. Probes are of little use.
Treatment of the Constitution
Bleeding should be used as in all accidents & 
according to the degree of violence received, & to the situation of the parts.
When the inflammation is considerable, we should be 
cautious of bringing the Patient too low, as that is the worst thing
that could happen. Bark should be given as in all accidents, & 
indeed Bark & gentle bleeding, is the best treatment I know of 
Where the ball has simply passed thro’ the soft parts
slough & heal the wound as in any other accident.
When the wound is complicated with extraneous
bodies as pieces of Bone & they stoon stop healing, often getting into
an indolent diseased state, & continue in it after all extraneous substances
are removed.
When the bottom of the wound is diseased or extraneous 
bodies contained in it, the skin is tucked down & fungus rises in
the middle with a Fistula going down, if these will heal over so
much the better & form an abscess then all will come away at once
If the wound is in a soft part I would recommend this, as the only 


54
the patient is not troubled with a sore to dress in the interim
If only the bottom is diseased making a free opening may change
the disposition.
Lecture 23d
When Gun shot wounds are healing, great attention 
should be paid to the motion of the Joint, which the parts move
it that in some measure in proportion to the quality of new substance
which is formed.
Of Penetrating Wounds
Wounds which penetrate the Abdomen, Thorax, etc., are to 
be treated according to the mischief done. Those of the Thorax have 
been little attended to: A wound in the lungs is not always mortal, & when 
made by a ball is less dangerous, than when made by a sharp 
instrument because there is less loss of blood. If it is from a ball,
the external wound will keep open for any thing to be discharged by,
& the adhesive inflammation shuts out the general cavity from 
suppuration. If it is from a sharp instrument the external orifice
will collapse & unite & exclude external influence the vessels will
bleed more freely which will be coughed up & some of it will
pass into the cavity. If only a small quantity the absorbents in 
time will take it up, but if the quantity is large it produces
lowness, [illegible] on the Breast & difficulty of breathing from the 


55
pain expanding that side, & a quick & hard pulse. In such cases when we
are certain from the symptoms, of extravasated blood, the operation of Eypyema
should be performed as usual, or by enlarging the wound.
Of Amputation
Amputation of a limb should not be performed on the field
of battle, because the Surgeon has not time to understand the case, & we find that 
the person cannot bear such an operation suddenly, * if even the limb should be
very much shattered, so as even for the consequent inflammn to endanger the 
Patients life still he will be as little able to bear amputation, & experience shows
it should not be practiced. If the limb is so torn as to be lost to the constitution 
certainly take it away. Tying of blood vessels, replacing parts which would 
prove fatal if left, taking out pieces of shells etc., must inevitably be done
on the field.
Of Poisons, Lecture 34th
Our ideas of Poisons are very undetermined; any thing
which makes the body worse than when it was taken may be termed a 
poison. Any substance which by its specific virtues is capable of doing hurt 
in health & in all diseases is properly a poison. All substances will
produce bad effects when joined with quantity, but even those whose specific
properties to kill, must be limited to a certain quantity, & this will 
give the difference between poisons & medicines. And if we are ever able 
to ascertain the quantity of all substances what can be taken 


56
with safety, & apply these to salutary purposes we may lose the
idea of poisons altogether. Our ideas of Poisons are very vague, we
give the name from the effects being obscure, not understood, & not
to the substance. For the same substance may or may not be called
a poison, according to our understanding its effects.
A mischief done which is incurable, or only by a specific
gives the idea of a poison. The definition of a poison should be, a 
substance always producing mischief in the smallest quantity
conceivable, as most of the morbid ones.
The Ancients were very superstitious in 
poisons as there was something mysterious in them & from ignorance.
they supposed some hidden way of doing it.
Of the applications of Poisons
Poison may be applied externally & internally, but 
their effects are not as the application, but as the specific virtue,
or that joined with the application.
Poisons either act Chemically, Mechanically,
or upon life. Chemical Poisons act always locally, as do also the 
Mechanical ones. Those acting upon life, act either locally or 
constitutionally.
All effects which kill in either of these three different 
ways are not called poisons, only such as act seemingly by some
hidden powers.


57
Poisons attack the body in three different ways & in one mixed one
First they attack locally, as we see in the three different actions (viz) 
powdered glass, merc. sublimat. & Lancet.
The second affecting the constitution without being traced
into it as in the morbid only, as jail fevers
Thirdly the whole system sympathizing with one
part, which is by [Honey]. Muscles etc. this part is not visibly affected
so the Chemical & Mechanical actions do not produce it. The compound
may be divided into the two first acting upon the living power of a part
& then affecting the constitution from these effects as the Lues Venerea.
Secondly, acting locally & the constitutionally or acting constitutionally 
by invisible means as the small pox. We may add a fourth manner
of the acting of poisons (viz) affecting the constitution from contact,
& no local effect produced, as the Plague. As poisons in general produce 
an ulcer & the constitution is affected from it, we have a means of 
removing it in our power. Poisons are produced from Mineral
vegetable, & animal contraction of matter, from the last the morbid.
Minerals act mechanically, by tearing or altering the mechanical
structure of the parts, as powdered Glass.
Chemically by destroying the arrangement upon
which life depends, as Acids, on life itself without affecting the 
organization as Lead, altho’ it may likewise act chemically.
Vegetable Poisons seem to be the natural secretion of the Plant 


58
and act in all three ways
Animal Poisons act principally on life,
not having any mechanical effects
Animal Poisons are either natural or morbid.
Lecture 35th
Natural poisons are intended for particular
purposes, & make a part of the [economy] of the Animal possessing
them. The parts containing & for their conveyance are not affected
by them, but any other part of the animal may be poisoned by 
itself. They do not give the same Poison, with a power of giving
it to those they poison, as in the morbid.
They may be received in two ways (viz) 
one only by wound, the other by simple contact, as the [Ant]
& some have this power in every part, as in the blubber & Medusa
Their effects are very quick as they are both for 
offence & defence. Their violence seems to depend on quantity.
They all seem to act on the part, & thence on the constitution 
by sympathy or absorption.
Local effects
The adhesive inflammation takes place as the
part swells, but they do not always suppurate, as a sort of desolution 


59
of the parts takes place producing extravasation, pain is felt & if absorbed
the pain runs along the Lymphatics, red streaks are seen, the
glands swell, a cold shivering comes on, then a hot fit, convulsions
& often death. The tumefaction spreads very considerably, the 
surrounding parts sympathising. The glands suppurate, & when 
they do the matter is not the same as the poison, as then they 
could not recover.
Some insects poison in the action of taking their
food, but probably they only suck the extravasated Juices
which are produced by the inflammations they set up
Morbid Poisons 
They must originally have arisen from a diseased
state of the Body, or parts, from accident, or spontaneously
Morbid poisons are either locally constitutionally
or both received by contact or effluvia. They arise either from a diseased
constitution or parts, which may be either from the constitution originally
as in a mode or spontaneous, & they must arise from a Stimulus or
disease. They give the power of conveying it along with the disease
& all parts are liable to it. Those arising spontaneously seem
confined to a certain class of Animals, some affect all animals, 
others only a certain class, some wear themselves out, or the Body
can only be stimulated by them for a certain time.
This must be either fluid, or vapour, before they can 


60
produce effects. They affect either constitutionally locally or
both.
Of Local affection
This is divided into two, where it either arises
spontaneously, or from violence, as cancer, or here from touch
simply, as Itch
Of Constitutional affection.
This is of two kins, one from effluvia, as Jail Fever
perhaps this might be inoculated, & then it would class among the
compounds as Muscles.
The second when caught by contact
only, as the Plague.
The compound affections may also be 
divided into two, one when the constitution may be affected by 
effluvia, & also local effects may at first be produced, & from
these constitutional, as the small Pox. The other where the effects
must be local first & received by contact, & from these the constitution 
is affected as the Venereal Disease
Lecture 36th
Introduction to the Lues Venerea
The Venereal disease which is one of the compound
Poisons, affects both locally & constitutionally. We only know 
its effects


61
It is capable of being communicated by the person affected. It is always 
in the form of Pus, which shows that inflammation always accompanies
it. The only way of communicating this disease is by the application 
of the matter. Its effects as either local, or constitutional. The local effecgts
are of two kinds; When applied to a cuticular surface an ulcer is 
formed. When to an ulcer or secreting part, the discharge is only increased,
& the matter in both cases immediately becomes the same as the matter
applied. These two local effects have exactly the same properties, one
producing the other equally, & also the second untill it is a pox.
The second or constitutional effects of this poison are
more complicated, & may arise from these local effects, from simple applicn
to internal surfaces without local effects, or from being applied to Ulcers.
It has no effect on the stomach, but is digested & no
secretions are contaminated by it.
When it is in the constitution, ir produces
local effects on different parts, but I very much doubt the matter
from these being venereal. These local & constitutional effects are 
perfectly independent of one another when produced both in the diseas’d
state. The other species of local effects are also entirely distinct, the 
one being cured without affecting the other, only the having of one 
seems in some measure to be a preventative against the other.
This disease seldom interferes with any other,
neither rising from nor terminating in other diseases.
The symptoms may however arise from some other 


62
complaint, it having none peculiar to itself, so that to ascertain 
its being venereal we must consider a number of leading
circumstances
Lecture 37th
When a secreting surface only is attacked, the
effects can only last for a certain time, & then vanish, as Agues.
Application of fresh matter has no effect in
keeping it up, as the parts have received the Stimulus & can
have it only for a certain time. I can conceive by keeping
up the stimulus when its action by habit is destroyed when
getting well of the Clap would prevent future infection as 
long as it is so kept up. this is strengthened by experience,
as in people who are always connected with suspicious women are
seldomer affected; & the effects of the disease are most violent when 
fresh, afterwards becoming very mild & slow. This inflammn
seems in general to be very circumscribed & confined to the
part which receives the infection, the surround parts 
not sympathising with it. This inflammation seems also 
confined to species, the matter from a clap not producing
Chankers, & that from Chanker not producing Clap.
Where the constitution is affected we may 
suppose all our secretions would be so too, but this is not the case.


63
When a secreting surface is affected, the discharge is increased to
wash away the irritating cause, but it is altered & becomes poisonous,
so that the effect cannot be produced but this matter does not continue
The disease & in time the irritation loses its effect, & the discharge
ceases; the time of this will depend on the aptitude of the part
for such irritation as we see in practice.
Whether the symptoms are attempts to throw
off the disease is not known but most probably not, as the matter
in them is not venereal, & the reason why the disease cannot Cure
itself is, that it can stimulate the constitution to all eternity
Parts most susceptible of the second Species
Some parts are more readily affected than others, 
both from a greater disposition in those parts, & from other circumstances,
joined in its first state, The skin, Tonsils, inside of the Mouth, Nose,
& throat are generally affected first; where more accumulated the 
Periosteum, Fauces & Bones. These are affected from the circumstances
of their being exposed & subject to variation of heat & 
cold; & only the sides of those external Bones are affected, joined 
with its hardness or quantity of earth. The parts actuating cold 
are first attached, then those within the power of sympathy, till 
the poison is accumulated so as to affect the whole. Hence in 
hot climates the disease is more mild.
As the disease when recent never affects internal 


64
parts, so when the external parts are only abated & it breaks 
out again, & it does not affect those parts again, but the more
deep seated ones; Those parts perhaps being now less liable to be 
stimulated; but it is possible recent poison might produce the first 
stage again.
Lecture 38th
The Cause of the Poisonous quality
It has been supposed that there is Fermentation
in the matter. But I should rather suspect that the Animal
body has a power of producing matter according to the Stimulus
applied. Supposing it Fermentation, there is no specific
inflammation, the matter being fermented after it is formed by 
Poison in this case what becomes of the Fermentation, when 
the discharge ceases & returns. If Fermentn it must
go on as long as there is any matter which is not the case
in a Clap. If Fermentation, all cases must be alike, that is, if
there are the same number of fermenting places; & by applyg
venereal matter to a sore, the matter would always be venereal,
which is contrary to experiment.
The effects of the venereal poison seem 
to be, the parts acting according to their stimulus, & in proportion 
to the susceptibility of the living principle for such irritation.



65
I therefore suppose it a poison stimulating living parts in a peculiar
manner so as to produce a specific inflammation, & matter peculiar 
to itself. My reasons for thinking so are
1st It irritates more than common matter.
2dly It produces specific disease with specific symptoms.
3ly It cures itself.
4ly It is confined to space
5ly A Venereal irritation can be destroyed by a common one
either for a time or wholly 6ly some parts are more readily stimulated than others
Of other Poisons
Hydrophobia is a specific stimulus affecting particular
parts, & producing matter capable of giving an other the disease; How
the constitution gives it to the Saliva is not easily determined, unless a
Fever is produced, which affects the Glands of the mouth, or else the 
poison circulating in the juices only capable of affected these parts
Small Pox produces matter from a specific stimulus, as
only capable of affecting particular animals. Epidemic disorders may 
arise from certain states of the Air, stimulating in such a manner
as to produce a Fever. Which effluvia may stimulate in the same
manner. Every infectious disease has its particular mode of affecting,
as the Itch by the hand, & the venereal disease by the genitals. But
there is no part of the body which may not be subject to this disease.


66
Clap in Men Lecture 39th
Sometimes the external surface of the Glans 
alone is affected, & secretes a thin matter without having a cuticle
but this is hardly perceptible.
The common seat of a Gonorrhoea
is in the urethra from an inch to an inch & a half along the Canal
& I suppose it to be translated therefrom the Glans or orifice of’
the urethra; sometimes there is hardly any inflammation & 
sometimes it is very considerable.
These symptoms generally attend clap,
(viz) inflammation, Pain, & discharge of matter, but sometimes
one, & sometimes another appears first
First generally an itching takes place, 
fullness of the lips of the Urethra, & [running]; tho it doe afterwards 
change to pain the Penis is fuller, the Glans is transparent, & often
excoriated especially near the orifice secreting a thin matter; the
canal is tighter from the fullness of the Penis, & inflammation in 
the passage. The urine is voided in small quantities & that often 
in too or more streams from inequalities in the passage.
Chordee
This is simply an effect of inflammation arising
from its attacking the cellular membrane, deep seated & making 



the part inflamed less pliable, this is generally on the lower part, but 
happens to the sides likewise.
Discharge
The natural discharge is altered to a watery whitish
fluid, & from that to one more like Pus. Then deeper seated glands of the Urethra
& the internal surface, all add to the discharge by their secretions being
increased. The matter is often green or yellow, (but this depends on inflammn)
& probably tinged by blood. That part of the urethra only, where pain is
felt, produces the discharge. The Perineum, Anus, Buttocks & Loins,
sympathise, giving a very uneasy sensation; the Testicles swell from 
sympathy & also the glands of the Groin sometimes, but do not suppurate
This irritation extends sometimes thro’ the
whole urethra, & then there is considerable pain the Perinaeum,
a spasmodic contraction of the acceleratous urinae Muscles, & of the Erectous.
The inflammation sometimes goes so deep as to 
form abscesses in the deeper seated glands & attacks even the bladder itself
in which case it can’t bear distension, & the pain is violent both in 
the bladder & Glans. The Kidneys & ureters sympathise with it
Swelled Testicles
This is sympathetical, the Testicle increases
in size, becomes painful & the Epididymis is very hard, & the vas deferens
is hard & sore. The spermatic Cord is often affected. There is also a pain in 
the Loins, & a weakness in the small of the back, perhaps from their former
situation.


68
There is sometimes a chain of knots or hard chord
running along the back of the Penis, pointing to one of the Groins.
This is probably a step towards a Pox & more frequently happens
when the prepuce swells.
The variety of symptoms are endless, & 
sometimes one appears first & solely, & sometimes others & so on.
The time of the effect of the Poison after application
is 6, 8, 10 or 12 days, sometimes only 24 hours & sometimes
so long as six weeks, but it does not always lie quiet so long, affecting
the constitution pretty considerably, without any discharge having
appeared
Lecture 40th
Clap in Women
The Clap in women is less complicated than 
in men, the parts being more simple & fewer, but these parts
being subject to a discharge *called Fluor Albus) & as the same symptoms
are attendant on this, as on the Venereal disease, they are not easily 
to be distinguished the one from the other. The only way to judge is
from other circumstances as the quantity & colour of the discharge
varies as much in the Fluor Albus as in the Clap. From all 
which, women may be clapped both unknown to themselves & 
the Surgeon.


69
The difference between the Clap in men & in women which is so great
arises from the difference of the parts affected. The Vagina which is 
principally affected is not very sensible however there is frequently 
a soreness in the Nympha, inside of the Clitoris, Caruncula [Murtiformis], 
orifice of the meatus urinarous, & often this its whole length,
the urine gives pain, the bladder sympathises, & the Kidneys may 
have the irritation carried to them. These symptoms have little
variation except in passing the urine; It is impossible to say
positively that a woman is clapped without knowing it, for altho 
she may have given the disease, the poison may have lodged
in the Vagina & taken up by another without her being
affected. Even a Babe being produced does not prove it as that
might have arisen from absorption without having produced 
a clap
When the Urethra is affected, the symptoms are
more violent, the parts inflame & swell, & there is pain & a 
discharge. These symptoms go off in time, as in men, without
any specific being used, as in them also.
In the Vagina it would seem to last
for years, perhaps from its being less sensible. Sometimes
the deep seated Glands of the Vagina have been affected & have
had an opening formed into it. Sometimes the Venereal matter
runs down to the Anus producing Chankers, or a Clap in the
Perinaeum



70
Effects on the Constitution
A Clap is entirely local, yet the constitution 
is affected sympathetically, & small rigors are felt before the discharge 
comes on, more so when it is late in appearing after the time of 
application, so that the inflammation however small, produces
the suppurative fever in some degree in the Constitution
Cure of Clap. Lecture 41st
To cure a Clap it is necessary to alter the Disposn
of the solids of the part, & the poisonous quality of the matter will 
also alter, for the which we have a specific. Time will certainly 
effect a Cure; but how far can we assist it is not certain.
The different modes of practice are internal
medicines & local applications. The internal are either evacuants 
or astringents which have been various, some adopting mercurials
others carefully avoiding them, yet under all the different methods
the Patients have got well.
Local applications seen to bid [illegible]
for a Cure, coming immediately in contact with the parts
when disposition they are to counteract & are either solid or fluid.
The solid ones where the parts are able to bear them, are
preferable from the continuance of their application.


71
Of Injections
Injections are as various as internal remedies
yet they would appear often to have an immediate effect upon the disease
but which are the most efficacious we don’t know; all those of the same
quality seem to be equal in their effects, they cannot be too often applied
when of service, & they frequently stop the discharge, tho’ the inflammn
continues sometimes, it will go off
Injections are irritable, which irritate the parts
more & so counteract the disease, they do not answer when the inflammatn
runs very high, as the constitution is very irritable. Astringents act
in some degree as irritating, they stop the discharge & the inflammation
will even continue longer than if it had not been used.
 Sedatives will be of service only as they are comfortable
to the patient. Emollients can only cleans yet they are often of service.
The external local applications are Mercury,
Poultices & Fomentations, which are of little service except the external
parts are affected. When the inflammation produces a bleeding
from the Urethra Bals. Capiv. is of service. The best thing for
a Chordee is bleeding the part with Leeches, & afterwards rubbing in 
Mercury to assist the absorption of the extravasated juices. When the 
disease goes on to the bladder, opiates, Glysters, the warm bath, & if
nothing forbids it, bleeding will relieve, tho’ most probable it will
go off of itself. When the Testicles sympathise & well [illegible] and
an Horizontal position are necessary, if not, they must be suspended 
& treated as inflammation in general.


72
Of the Constitution in the Cure of Claps
Lecture 42d
If the constitution is plethoric & subject
to inflammation, Evacuants, Fomentations, & every thing that will
diminish the inflammation should be used.
If the constitution is nervous, instead of 
evacuations, the Patient must be strengthened. I have seen 
constitutions which were never well two days together, & which 
by giving the Bark had all the symptoms very mild
Some constitutions are exceedingly affected in this
stage of the disease, & others not at all.
In some an accidental Fever will Cure 
all the symptoms, in others they will go away & return again 
with the going off of the Fever.
This disease like all others will be 
affected by whatever affects the constitution. The symptoms will 
be increased by hard drinking, high living, much exercise etc.
Claps are to be cured like all inflammations
by paying attention to the constitution, & to the parts affected.
Signs of Cure
All the symptoms gradually abate & vanish
sometimes they will return, how far the second attack is [illegible]


73
is not ascertained, frequently little shooting pains in the urethra will
continue. These effects which are only sympathetic, may stay longer
or go off sooner than the other symptoms. The swelled Testicle is generally 
tedious, & the Epididymis remains swelled, for years, & I believe in such 
cases they are often useless, but not always.
The Chordee is generally later
than the other symptoms but gradually goes off There is a spasmodic
Chordee going off & returning, in which case Bark is of considerable service.
It will be necessary to give small doses of Mercury 
towards the end of the Cure to prevent a pox, & more so if it is Cured by 
physic simply & if the discharge has been of long continuance.
Cure in Women
When the disease is in the Vagina, Injecting, 
washing the parts well, & rubbing with Mercurial ointment will in 
general cure all the symptoms, but it will be difficult to ascertain the Cure.
If the ducts & even the Glands of the Urethra are
affected, the same treatment is to be continued, & if they suppurate they
must be opened & treated as Buboes. In a simple clap the constitution 
must be treated as in man, & when suppuration takes place, as in Buboes


74
Gleet Lecture 43d
The continuance of the discharge after all Virus
is gone off is a Gleet. It has no specific quality, but depends upon the
constitution or the nature of the parts themselves. It may be attacked
constitutionally & locally by strengtheners, Astringents, specifics & 
violence. Violence should not be used untill all the others have failed.
Violence increases the discharge for the time, therefore
a time should be fixed for the Cure of the disease, & this will be longer
or shorter according to the quantity of violence. The methods which
are used should be continued after the symptoms disappear for sometimes
to destroy the habit of the parts & this time must be in proportion
to the length of the continuance. Strictures do not arise from Claps
as they are in all passages, & they are in general, not in the same
part of the Urethra, that is attacked by the Clap. A stricture is a 
contraction of some part of the Urethra, but whence it arises is impossible
to say, it is of no extent in all the cases I have seen, & it is 
white, & harder than any other part of the passage. The course of 
strictures, is by dilatation or erosion.
Dilatation is entirely mechanical & done by 
Bougies. If one can get by perseverance a small Bougie to pass,
we have then the disease within out power. if after repeated trials
it cannot be passed introduce a larger bougie close to the stricture & 
leave it there, & the new formed parts will intime ulcerate to [illegible]



75
the Patient you may change the colour of the Bougie. Therefore applied
in passing a Bougie should be small, for fear of its slipping & making a new 
passage. To know if the Bougie has entered if it is not easily ascertained
examine the end of it, & see if it is marked with the stricture or not.
When a Bougie has been once passed the size is to be increased
untill the Patient makes water easily
Spasmodic Stricture, Lecture 44th
There is often a spasmodic contraction of
one part of the Urethra, shooting up the canal entirely, & this is frequently 
only temporary. In these cases Opiates & Turpentines are given by the
mouth, & injected by the Anus, Fomentations are applied to the part
& if these fail a Catheter is used. The Bougie is safer, & is generally 
sufficient, it should be left in untill the desire of making water comes
on, & it often need not be passed farther than the stricture. In these 
cases the passage is very irritable.
Mixed Case, A stricture with an 
occasional spasm, & consequently the passage is irritable, as in the 
Spasmodic. It is singular that a discharge as the Clap, cures the
stricture for the time being. A Bougie may be applied to the stricture
& perhaps by being kept there sometime it may be passed
Buboes arise sometimes sympathetically from
using the Bougie. The Testicles also swell



76
Diseases in consequence of Strictures
The Urethra is enlarged beyond the Stricture, and
is irregular, which subjects it to inflammations & irritations.
Abscess in [Perin??]
These inflammations between the 
stricture & bladder suppurate & like all abscesses, point externally,
but often burst internally, & the urine gets a passage into the abscess.
When they open both ways it becomes in time (from the urine passing thor’)
a Fistula in Perinao.
This disease improperly managed lays
the foundation for suppuration in the surrounding parts 
all which have separate openings altho’ they communicate
with the original disease.
When the abscess opens externally only,
it is but a common abscess. In these cases from the inflammation
the sides of the passage are squeezed together & the patient cannot
make water. In which case introducing a Catheter is the best
practice. The bladder in these Cases being constantly distended
is more frequent in its action, & it becomes more violent in proportion
to the resistance it meets with. From the constant action the bladder
is increased in thickness to a very great degree. In some cases 
the ureters are also much distended, & the Pelvis of the Kidneys
are affected.
All strictures are attended with a discharge or Gleet,
from the constant irritation kept up in the parts beyond it.



77
The urine is in general stale before it leaves the bladder.
Cure of Abscess in Perinaeo
When such inflammation is begun the
stricture should immediately be attempted to be removed
If it suppurates open it as soon as possible
If the abscess opens internally & the stricture still exists, the matter
will pass into the bladder & come out with the urine. If the stricture
is dilated the abscess may be washed by introducing a Catheter into
it. When the abscess opens both ways, the external opening should 
be freely dilated & a Bougie kept in the Urethra constantly only 
drawing it out when the patient wants to make water
Hollow Bougies are recommended in this case but do not answer 
Lecture 45th
Bougies are mechanical instruments whose
powers depend upon their external form, their length should be about
eight inches. Their thickness at first should be just sufficient to pass
with difficulty, & are to be increased in size untill the Urethra is of
its natural size & then kept at that size for some time
Their consistence should be varied according to the nature of the
case & size of the Bougies.
If the stricture is near the Glans the Bougie
may be pretty stiff & nearly of equal thickness as a short Bougie
will always have sufficient strength


78
If the stricture is near the bulb it must be thicker, (except at
the end) to support the pressure, & if the stricture is in the curve it
should be flexible. The composition is wax oil & [Litharge] the
last ingredient is added to give smoothness
Seminal weakness is not the consequence of Venereal
disease It is a discharge from the prostate gland & Viscula Seminalis
coming away with the last drop of Urine & when the Patient goes
to stool This disease is not well known, it was thought to be 
a seminal discharge & was supposed to weaken the Patient, how far
the cause of such discharge may weaken him I do not know, but the
discharge itself does not.
Consequences of a Gleet in Women
A Gleet is more frequent in Women than 
in Men, or at least the Fluor albus after a Clap will be called one
The method of cure is the same as in Men only we
cannot recommend the Bougie in the Vagina They are subject
to a stricture in the Urethra but not from a Venereal Course, as
Women have it who never had the disease
Chancres
Chancres are an ulcer or loss of substance, the only means
of producing a discharge on such a surface
These are in proportion to Clap as one
to three or four. They are generally upon the [illegible], Glans, 


79
prepuce, common skin of the Penis, or fore part of the scrotum, arising
from the manner of catching the disease. The time between the 
application of the virus & the effects, is rather longer than in Clap
but this depends upon the nature of the parts some appearing in 
four & twenty hours, & I know an instance of its not appearing before
seven weeks.
It comes on with an itching. If on the Glans, there
comes first a pimple full of matter with a little inflammation,
if it comes on the Frenum, prepuce the inflammation is greater,
the itching changes to pain, there is circumscribed that [illegible] of
the part, then either ulceration takes place or a small pimple
forms an ulcer.
Chancres appearing, often explain the nature
of the constitution at the same time. If the inflammation spreads
first it shows there is a disposition in the constitution to inflammation 
If the pain is great it shows a disposition to irritation. If they form
sloughs & bleed freely, it shows a mortification. From these signs
we lay a foundation for the manner of Cure.
The Urethra sometimes sympathises with them
& here there is a tickling pain running along with it. The 
Scrotum & Testicle also sometimes sympathise. When Chancres
are on the body of the Penis or Scrotum they generally appear first
in a pimple


80
Phymosis & Paraphymosis
When the prepuce is attacked a thickening
of the cellular membrane is often produced in consequence of
inflammation, which is sometimes Erysipelatous & there is
often very considerable tumefaction & as it is a depending part
it cannot escape. This tumefaction when the prepuce is before 
the Glans, passes so closely on the Glans from the inner surface
being diminished, as to prevent the discharge from any Chancres
behind it, & they will burst externally like an abscess. Some
have a natural phimosis
When it is behind the glans it is more
dangerous, as the reflection of the prepuce is less elastic than the 
rest of it. It grasps the neck of the Glans very tight & in proportion 
to the degree of inflammation. The circulation of the prepuce
behind it is often stopped, & mortification comes on in consequence.
In Women Chancres are on the inside of the
Labia & Nympha, the matter often runs down from them upon
the perinaeum & forms Chancres there. Chancres have been seen
in the Vagina, tho’ most probably the originated in the Nympha.
This species of the disease is entirely local, 
the constitution only acts sympathetically. 


81
Cure of the second species of Chancres
Lecture 46
On their first appearance they may 
be destroyed by Caustic or incision & the sore healed up as a common one.
The constitution is very seldom affected, yet this should not be relied on.
Chancres may be cured locally, & constitutionally, by the
same Medicines. The local applications are Mercurial Ontt whose
powers are increased by warm balsams & red precipitate in such 
quantity only as to stimulate the parts. If watery substances were
used instead of the oily, the application would be larger & prove more
effectual by mixing with the matter & keeping to the sore. When the 
prepuce is tumified so as to be kept before the Glans, the Chancres must
be washed by some mercurial injection & ointment 
forced in after it is cleaned. The Penis may be being over warm
water & spirits, & then put in a Poultice of oatmeal & Linseed
poultice.
In such case care should be taken when the chancres are
healing to move the prepuce to prevent its adhering to the Glans,
which is often very di
sagreeable for the orifice becomes very much 
contracted, & is often not exactly opposite to that in the Glans so as
to admit a Bougie in which Case the prepuce must be opened untill
a passage is found for the Bougie, & the superfluous prepuce may 
be cut off.
Internal medicines should be given to present a pox
& to assist the local ones, no chancre can withstand both


82
What quantity of Mercury is to be given is not known,
it will be right to give enough to Cure a slight Pox
The operation of the Phimosis is
performed by slitting the prepuce near its whole length in the
direction of the Penis, sometimes on both sides – The root of the
prepuce should in these cases be exposed or no good can arise
from the operation. This tho’ the prepuce cannot be drawn back
allows a discharge of the matter & the power of applying dressings.
But it often is so violent that an operation is improper 
by increasing the inflammation when violent, & bringing
on mortification; sometimes by freeing the parts, mortification 
will be prevented. Mortification sometimes comes in altho’ the
operation is not performed, in which case there is probably 
a tendency in the constitution to Erysipelatous, in which case
the Bark should be given plentifully.
Paraphimosis, is where the prepuce in such 
circumstances draws back & is relieved by cutting the tight
part & that alone, which may be done by a pointed crooked Bistory 
the operation is here even more necessary than in the Phimosis,
as besides all other symptoms, the prepuce itself may produce
Mortification



83
Lecture 47th
If the prepuce still remains tumefied & projects
beyond the Glans, after having used the steam of warm water & 
fomentations of Hemlock, have been tried in vain, it must be cut
off, all the projecting part beyond the Glans must be taken off
& this is best done by the Kinfe & healed up as in common
wounds.
The cure of Chancres in Women is the same as
in Men, little more is necessary than to keep the parts clean, & 
to rub them with Mercurial ointment. When the ulcers run up 
the Vagina, great care should be taken in healing them & a substance
should be kept in to prevent the granulations from contracting 
& pressing it up. They will sometimes break out again after
all the Virus is gone off, & this will happen in some periodically 
& I know no cure for it. Sea bathing has been recommended,
but with what degree of certainty I can’t say
Warts.
Chancres often heal into warts & arise from the
surface on which the matter has laid. A wart is an excrescence
of the Cutis covered with the Cuticle & does not spread at its basis 
but has a power of growth within itself. They are principally 
diseases not truly animal. Stimuli make them decay as Copperas
& [Lavin] leaves mixed. Excoriation acts also as a Stimulus & they 


84
soon decay. Methods of receiving the second species
of Infection
This species is whilst circulating in 
the vessels. It stimulates them to this inflammation & 
suppuration. It is produced by the absorbents taking up 
the Venereal Matter either from surfaces or sores. This
matter may be taken up from a surface without its
having produced any local effects, having simply been 
applied there. It may be taken up from the inflamed
surface in a Clap. It may also be taken up from an Ulcer
which is the best absorbing surface.
It is the least frequent from the first 
way, but more from the Second, & by much the more so
than the last. 
In this first case there is no method
of preventing absorption but by wiping off the matter.
In the second the Clap may have been 
perfectly cured, yet absorption may have taken place & 
in the third the cure of the local complaints prevent the 
possibily of a Pox ensuing



85
Buboes Lecture 48th
The venereal poison in its way to the constitution,
often affects the lymphatic vessels or Glands, when it affects
a lymphatic vessel, the vessel inflames & becomes a [Cord]. Suppuration 
takes place in different parts of it, forming Buboes or Abscesses
When it is in the Glands, probably from its
course being slower there, & their situation always the same 
it is sometimes pretty low down the thigh, the nearest Glands only 
are affected, perhaps it is too much diluted before it comes to the
next & if the next Glands should be less superficial they may be 
less easily affected. In women of the Chancre is in the Perinaeum 
the Bubo will be in the angle between the Labia & Thighs, if it is 
higher it will be on the left rotundum, these parts, jut out before
they enter the abdomen.
Cure of First Class of Buboes
They should be prevented from suppurating 
if possible. In either state it must be done by Mercury, it should 
be rubbed on the body of the Penis, but as that surface is not
large enough, it should be given internally in pretty large
quantities both to prevent a Pox & to cure the Bubo


86
Cure of the second Class of Buboes
Before suppuration their situation 
should be considered & the mercury rub’d in beyond it
so as to pass through it in its way to the circulation, & 
if that surface should be too small, more Mercury should
be given by other means. The antiphlogistic methods
can have no effect on the specific disposition of the Poison,
but only lessens inflammation. Vomits are very powerful 
in retarding Buboes even after matter has formed, they 
acting by revulsion.
If the Bubo can’t be put back and 
suppurates, it is to be opened as other Abscesses
and dressed accordingly, & the constitution is to be attacked
with Mercury The proper quantities of Mercury can’t 
be ascertained, but should be given for some time after the 
Bubo has healed. In Women the situation is to be consider’d
& the Mercury rubbed in accordingly as in Men, when 
the surface is too small, Mercury must be given internally.
Sometimes after all the Virus is gone, these 
sores do not heal, arising both from the disease & manner
of Cure. We should [up] in such cases Hemlock internally 
& externally, & perhaps Sarsaparilla may be of service


87
Lecture 49th
When the disease is in the circulation, it has 
the whole body to work upon & appears in a many different forms,
varying according to the time, the kind of constitution, the parts affected etc.
The first appearance is generally in about 
six weeks, tho’ I once saw it appear in a fortnight. The effects in 
the constitution seem to be according to the time it has been there, for if
the disease is not cured on its first appearance, it is only the 
appearance that has been cured, it returns & is more serious, & 
attacks parts which are deeper seated, the first by continuance appearing 
to lose entirely the power of being affected by this Stimulus.
Each attack is slower & slower, & as it is more habituated
to it is harder to eradicate tho’ not more violent.
The first appearance is in the skin or throat
differing according to the parts
The appearance on the skin is often first
but sometimes those of the throat are equally soon
They come out all over the Body making the
skin mottled from the inflamed cutis shining thro’ the Cuticle
they then become copper coloured scales, which are thrown off
& new ones come on thicker & thicker, & at last matter is formed under 
it they generally spread to the size of a sixpence & seldom broader.


88
Those inflammations & ulcers from the constitution
are attended with little or no pain.
It often attacks the fingers under 
the Nails & then the Nail will be separated on the Cuticle,
but there will not be that succession as in the Cuticle
If the skin is opposed by an other skin 
it arises in a white watery surface instead of scabs
When the throat is attacked by this
inflammation an ulcer is soon formed, which is foul spreading
with thick edges & these are more painful than the blotches & 
less so, than a common sore throat. If the disease is still left
to itself or only partially cured, its second attack is in 
general more violent & universal. If still left longer besides 
these, the deeper seated parts will be affected, & if still longer
the Periosteum & then the Bones.
Every latter effect is slow in appearing
more rooted & more difficult to cure.
The frequency of its appearance seems 
to alter its effects appearing less & less on the skin & hardly 
getting beyond the adhesive inflammation, & a constitution may 
not? be so habituated, as to have any effect produced on it by this Poison.
The matter from these sores will not give the Disease.


89
The pain is very little both in the blotches, & Ulcers
on the throat more violent, & in nodes, probably from the nature of
the parts, they resist suppuration for a long time & the pain in 
them is more violent in the night.
Effects on the Constitution.
Some are from irritation & according to the
violence. When long continued it produces a Hectic disposition.
Before it appears there are Rigors Head Achs
etc. felt for some time, but from their slowness they are not always s
perceptible.
When it has been long in the Constitution, & the 
effects only kept under it is often attended with a continued 
Fever




Index to [illegible] J. Hunters Lectures









1
Of Strictures in the Urethra
by T T
1781
Strictures in the Urethra proceed from various 
causes, the most common is Gonorrhoea, but without doubt inflammn
proceeding from other stimuli as well as Venereal will produce them.
It is received opinion that the cause of the adhesion
which takes place during inflammation of certain parts of the 
human body, is an extravasation of coagulating lymph. It has 
been observed by Mr. Hunter that this extravasation however does not
take place in those membranes which he has denominated Mucous 
Membranes, & particularly not in that membrane which lines
the Urethra, otherwise the sides of this Canal would adhere & a total
obstruction would be the consequence of every Gonorrhoea. To avoid’
this the suppurative inflammation takes place. This stimulates 
the muscular fibres of the urethra to contract together with the 
swelling of the neighbouring parts, produces a diminution of 
the diameter of the Urethra
When the inflammation subsides these effects
generally disappear, but if the inflammation has been violent,
& of long continuance, there sometimes remains a narrowness of 
the Urethra at that part repeated inflammations of the same
kind at last produce a stricture


2
If the inflammation is so violent as to produce
ulceration, there is always considerable danger
of the formation of a stricture for in the Cure of this case
granulations are formed which often arise too high, & take
the name of Caruncles or Carnosities, which of course occasion
a stricture.
Dr Hunter says he never saw any Caruncles
or Carnosities in the Urethra, & thence concludes they never
exist, but this is contrary to the observations of other very 
able practitioners.
Daran, Sharp, & Mr Bromfield assert 
their having seen them in many cases upon dissections & 
DR. Osborne in his Lectures on the Lues Venerea particularly 
mentions several instances, not only in male but even in 
female patients, tho’ in the last much seldomer. Such a number
of witnesses must therefore have more weight than a single
author however great he may be, especially as the evidence
of those who support the existence of Caruncles are positive
whereas the single opinion is only negative
Caruncles occasioning strictures may arise 



3
from other causes besides Venereal inflammation, several authors
have asserted it, & there is nothing in the nature of the thing which
renders it improbable. The cicatrix of an Ulcer from whatever 
source it springs in the Urethra is an other cause of Strictures, 
for when it is forming, the opposite edges of the Ulcer are drawn
together that the cicatrix may be as small as possible, which 
necessarily produces a Stricture
There probably may be other causes of a 
Stricture, but these undoubtedly are the most common
The Symptoms are a difficulty of 
making water in general accompanied with a discharge of 
matter from the Urethra, & in bad cases a total suppression of
water takes place. Fistula in the perinaeum, pubes, & scrotum 
thro’ which the Urine passes are common symptoms in bad Cases.
The Cure
Various methods of Cure have at different
periods been recommended for this complaint, all of them however
are triffling & ineffectual, except that produced by the prudent 
use of Bougies. To cure a slight Case, a bougie of such a size as 
the Patient can easily bear is to be introduced into the Urethra
beyond the stricture, & there allowed to remain as long as
the Patient can suffer it without great uneasiness. The 



4
Patients feeling must regulate the time, for if the 
Bougie gives no pain to such an irritable membrane as
that which lines the Urethra, it is impossible it can 
occasion much inflammation.
Bougies are of three kinds viz. Escharotic,
suppurative & mild. Escharotic Bougies are I believe
now entirely laid aside, for this very good reason, because
they acted upon every other part of the Urethra as well as 
upon the stricture consequently did much mischief.
Suppurative Bougies are composed of substances
more or less stimulating, & ought also to be laid aside 
because they stimulate every part of the Urethra & bring
on a general inflammation.
Bougies only composed of perfect mild ingredients
ought to be used, & they will in general be found sufficient 
for a perfect Cure. They act in two ways (viz) 
First as a wedge, by dilating the Stricture, secondly 
by pressing upon whatever obstructs the 
Urethra, more than upon any other part of it, this
irritation brings on suppuration & ulceration by which 
means the stricture is removed.


5
What facilitates this is, that Caruncle, Carnosity, Cicatrix or 
whatever occasions the Stricture more readily ulcerates than any other
part of the Urethra. For all new parts are more delicate or easier irritated
than original ones.
This appears in old Wounds which so easily 
ulcerate on any irritating cause, & the Callus’s of fractured Bones
being absorbed in some diseases.
But it often happens altho’ the Patient
can make water in a small stream yet it is impossible to 
pass even the smallest Bougie beyond the stricture. In this
case a pretty large Bougie is to be introduced as far as the Stricture 
& retained then as long as the Patient can easily bear it.
Another is to be passed daily in the same manner
By persisting in this method a passage will at last
be made sufficient to admit a small Bogue, & then the disease
is in your power, for by gradually increasing your Bougie 
a complete cure will be formed. By this means the worst
cases, & some that at first seemed to baffle the power of Bougies,
will be cured. I have seen a Case where a Bougie was introduced every 
day for three Months before the smallest could be introduced beyond
the Stricture, but soon after, this happened, & a complete cure was
made.
The tediousness of this method induced Mr Hunter
to try whether a Caustic might not be applied, & by that 



6
means a much speedier relief be obtained.
He conveyed a piece of Lunar Caustic thro’ a silver
Canula into the stricture & by applying this every day
he hoped to destroy the Stricture.
The objection to the Caustic is, that
it is impossible to apply it with such precision to the part
you intend, as not to endanger the burning of the sound Urethra
which may produce the worst consequences.
I imagine every Stricture may be cured 
by mild Bougies properly used.
Total suppressions of Urine which 
may happen from too long a retention, from violent exercise,
& other irregularities are much more liable to happen to people 
who labour under a stricture than to others, & are more difficult 
to remedy when they do happen.
For if there was no Stricture the
disease would at once be removed by the Catheter. But when 
there is a Stricture totally obstructing the Urethra, if a Catheter
is attempted to be passed, great resistance will be found, & if 
it is forced on, a false passage may be made. And altho’ you 
should have the good luck to get into the bladder without 
any tearing, there is great danger of this forcing thro’ the 
Stricture, inducing violent inflammation, Fever & the worst 



7
of consequences. The most probable means of relief is by Foments
the warm bath, bleedings Opiates & Glysters, if they fail, then 
we must attempt to pass a very small Bougie, the means previously
used will facilitate this. Upon withdrawing it a little water will 
follow, by continuing this mild treatment the bladder will be gradually 
emptied, & a regular Course of Bougies will complete the Cure
When there is an Ulcer & Stricture in the Urethra at
the same time, the ulcer is more difficult to heal, & sometimes
becomes very inveterate from the constant irritation of the Urine 
& probably also from a bad habit of body. It will be the business
of the Physician to remedy the latter.
When the Urine by its irritating quality
brings on an Erysipelatous inflammation & ulceration, it 
insinuates itself into the cellular membrane, & falling into
the perinaeum, (being the most depending part) produces an abscess
which bursting externally, & part of the Urine continuing to flow 
that way forms a Fistula. In this Case it will be in vain
to attempt a Cure by external applications to the abscess alone,
we must in the first place entirely remove the Strictures by 
Bougies, & give a free exit to the Urine thro’ the natural 
passage of the Urethra, after wich the Ulcer & Fistula
will be cured by proper treatment The most common
seat of these Fistulae is in the Perinaeum, yet they are 
often found in the Scrotum & sometimes in the Pubes


8
The worst consequences of strictures are when having
occasioned an Erysipelatous inflammation the Urine 
works itself into the cellular membrane & diffuses itself
under the skin of the Scrotum, Pubes, & Penis, forming
an adematous swelling, which by continuing will occasion 
very violent inflammation & sometimes mortification.
The Cure in this desperate Case may 
be attempted by passing a hollow Bougie & retaining
it constantly in the Bladder, that the Urine may 
be conveyed out by this, without diffusing itself into
the Cellular membrane.  The Bougie will also distend 
& Cure the Stricture & permit the Ulcers to heal, & what
Urine remains in the swelled parts will be absorbed or
may be discharged by punctures. If this fails it may be necessary 
to make an incision in to the Urethra between the 
Stricture & bladder that the urine may be carried off by 
this opening, which must be kept open untill the Urethra
is cleared of Strictures, then the inflammation of the 
adjacent parts will gradually subside when no longer kept 
up by the irritation of the Urine
T. T.
















Upon opening the body of there were the follow’g
appearances. the Abdomen & Thorax both fill’d with water, more
in the right side of the Thorax than on the left, the Heart
considerably enlarg’d as well as Aorta & Pulmonary arteries,
a total adhesion of the Heart to its Pericardium, & a
little adhesion of the lungs to the left side – The man
before he died said that his Dropsy had been coming’
upon him about nine months when he came into the
Hosptl his pulse was intermitting, & he complain’d of a 
fluttering at his heart & he could not contain the least nourishments
upon his Stomach
I should suppose the adhesion of the heart to the 
Pericardium must be owing to an inflammation of the Pericard.
which consequently threw out a quantity of coagulable lymph 
upon the heart & by means of the adhesive Inflammation 
it became united to the Pericardium, the enlargement of the 
Heart, & arteries must be in consequence of the efforts which 
the Heart would make to throw the blood from it with its
usual velocity, which it could not possibly do being prevented
by the adhesions – the flutterings & intermitting Pulse owe
their origin to the same cause. The Dropsy was in 
consequence of the blood not being thrown thro’ the system
with its usual velocity, in consequence of which an 
increas’d secretion of the exhalants took place, the 
absorbents became deficient in their office, & thus the
water was accumulated




12 O’Clock his Pulse 140. The extremities were cold particularly the [feet]
& he prespired profusely. He wished much to sleep & was constantly 
attempting it, but in two or three minutes after closing his eyes he was 
awakened by a convulsive inspiration [illegible] in the morning he was ordered
the following
Rx Lin. Volat zii
Ol. Succini zii [dorso] applicand
Rx Enema Common zxii Tinct Thebair gr IX m. statim [injuciend]
N.S. [illegible] after bleeding the Pulse increased to 160 at least, at 
4 o’Clock in the afternoon, the Muscles were more contracted, but he 
breathed easier, the Pulse impossible to count it became so quick, & 
was much weakened. From this time till the time he died (which was
6 o’Clock the same evening) the Pulse became weaker, breathing softer 
& the Muscles became a little relax’d so that just before he died his
mouth opened a little.




16
Case of a Locked Jaw
Sepr 3d 1780
John Brown aged 18 years (& at the time he recd this accident) in 
good health, received a blow from an ax between anterior ancle & tendo
Achillis of the left Leg. The wound was two inches in breath & one in length
& by the manner in which the wound was made, constituted a Flap.
The ax penetrated thro’ the Skin & Fascia of the Leg; it was dressed superficially 
with dry Lint & over it a Bread & Milk Poultice. 4th He took a 
dose of salts, the wound was dressed with a [de??tive] ointment & Poulticed 
at night he complained of considerable pain which abated towards the 
morning of the 5th & he had a very good day, the wound beginning to 
digest & was dressed as before 6th in the morning the Muscles of the neck 
began to contract, & pull the head backwards; it spread to the Muscles of 
the back, which became very hollow. He had great pain in his back
but none in the Wound at 6 O’Clock in the evening his jaw began to close 
at seven O’Clock he began to breath irregular and at ten o’Clock, the
irregularity was much increased, & apparently he only breathed by 
the intercostals, as the ribs were much raised at every inspiration
at which time there was a spasm of the Muscles of the whole body
His Pulse was near 120, the heart contracted with great force also.
The Masseter muscles were evidently contracted. A wooden wedge 
was introduced with great difficulty within the teeth to keep the 
mouth open. The following Draught was given
Rx Tinct. [Fatid.]
[Thebair] aa gr xx
Julep e Camphor zivs cap. i 6tr quaq hora
Empl. Vesicat collo applicand




15
mortification, which destroyed the Patient
There are two ways by which this patient might have been treated,
with great probability of success
The first is by passing hollow Bougies & letting them remain constantly 
in the Urethra which would be a constant passage for the Urine
prevent it escaping into the cellular membrane, & at the same time
would distend the passage. If in spite of this treatment the Urine still
found a passage into the cellular membrane I would recommend the Second
way; which is to pass a grooved staff into the bladder, or if that was
impossible, to make an incision without it, into the Urethra beyond the’
Stricture as in Lithotomy by which the Urine would find an easy exit, & 
will give time to enlarge the passage of the Urethra by Bougies




14
18th The Pulse was fuller & less frequent & the tongue less furred,
but he was more comatose, & upon making Water he complained
of great pain about the Pubes which were very much inflamed
19th He was much worse & on the 20th [Obiit]
Upon examining his body after death, an ulcer above an
inch in length was found in the membranous part of the Urethra,
& a considerable abscess in the cellular membrane, at the Right sides
with which it communicated, The Urethra was very much contracted
here. Immediately beyond the stricture, (that is to say nearer the bladder)
there was a small orifice in the Urethra which led down to the fistula.
There was also a straightening of the Canal about an inch
within the Glans, from which there was a false passage above an inch & 
a half long which would admit the end of a Probe, this however appeared
to have done no mischief; The rest of the passage appeared to be pretty 
sound, but the bladder was much inflamed & thickened
The Cause of this Man’s death is very evident. The urine not 
finding a ready passage either by the Fistula or Penis, had caused Ulceration
upon the new formed parts viz the Strictures & in the cellular
membrane of the left side of the Urethra, & by straining the urine was 
forced down into the Scrotum the day before he came into the Hospl & 
had swelled & inflamed it, more Urine constantly getting down at
last so distended the cellular membrane of the Penis & Pubes (together 
with its irritating quality) that it caused inflammation and
mortification




13
the preceeding one. The Scrotum more swelled, & about 7 O’Clock in 
the eveng an adematous swelling began on his Penis.
15th His Penis scrotum a little distended with Urine. Mr [Hawking]
was sent for; who order’d him an anodyne Clyster statim injiciend. & a
puncture to be made in the prepuce to discharge the Water, the 
Vin. Antim. aa Tinct Thebaic aa gr xxx was given in the eveng. the
Bougies were omitted 16th [Spha??lus] attacked the skin at the root
of the Penis. The celular membrane of the Penis, scrotum & Pubes much 
distended with Water, although a considerable quantity came from 
him. His pulse was small and frequent & a cold sweat over his whole
body, the following Mixture was ordered]
Rx.
Mixt. Salin zviii
Conf. Card. Zii
Pulv. Cort. peruv. Zvi m. sumat cochl. 3a [larg.]
tertia quaq hora & Cap. Sp. Vini Gallic [illegible] in die.
Scarifications were ordered to be made into the mortified part & 
the Penis & Scrotum to be fomented.
17th he became a little comatose; his Pulse at above 110 in a Minute,
his tongue was much furred, & the mortification spread. His Urine 
continued constantly dripping from the Fistula & a small quanty 
from the Penis. He kept constantly dropping asleep, & was as constantly
awaked in about 5 Minutes by a violent spasm. The muscles of different 
parts of the Body, particularly those of the Hands & Feet, were constantly 
contracting. HE was ordered to continue his Medicines as before




12
A Case of Stricture in the Urethra
Robt Irwin aged 31 after repeated Claps was attacked about
nine years ago with a difficulty in making Water which 
increased soon very much by neglect; & a fistula in [illegible] was the 
consequence
Augt 10 he came into the Hospital. AT the time he came in  
he made a small quantity of Urine by the penis [gu??atim] but the
greatest quantity cam by the Fistula, from whence it was continually 
dropping. The day before he came into the Hospital the Scrotum
became inflamed, the Urine having escaped into it by a violent
effort to make water. Augt 12th Mr Hawkins attempted to pass
a Bougie, but could not introduce it more than an inch. He
ordered this to be attempted every day; & the Scrotum (which was 
much inflamed) he order’d to be Poulticed. In the afternoon after Mr. 
Hawkins had left the Patient, A Bougie was passed full three inches
into the Urethra & as it gave the Patient no pain, it was suffered to 
remain in three hours; after it was taken out he made water much 
freer, by much the greatest part coming thro’ the Penis
13th A Bougie was passed quite into the Bladder & suffered to remain
three hours. The inflammation of the Scrotum increased
14th An other Bougie was passed & suffered to remain in as long as 




11
Rx Opii pur. & Sacchar Saturn aa tr [illegible]
Cons. [Rosar] g. s. i fiat Bolus cap. 6ta quaq hora.
April 28th the Muscles of her back began to be affected, & the pain 
of her head was so violent that she could not sleep night or day.
she was ordered to take the same Bolus every three hours
she remained getting worse every day untill May 3d, & then the dose
of Opium was increased May 5th she was much the same, when 
MR. Hunter ordered a 
Opii pur. gr ii
Sacchar Saturn gr i
Cons. Rosar. q.s. ft Bol. 3to quaq hora sumend
before night after taking this Bolus she seemed better, the Muscles 
of her neck & back began to relax & the pain of her head not so 
violent May 6 & 7 she relapsed, & was then ordered to take the 
Bolus as before, & also to take 1 gr of Opium every hour. May 9th 
the Muscles of her back were entirely relaxed & those of the Neck
much better, & the pain of her head not so violent. She became
every day better & was discharged July 3d perfectly Cured of the Lock 
Jaw & the pain of her head




10
A Case of a Locked Jaw
Mr Hunter having found the inefficacy of Opium 
& the other antispasmodic Medicines in curing this terrible
complaint, (altho given in a great quantities as the Patient could
bear) resolved to try what effect Sacch. Saturni would have.
He found his hopes of a Cure from this medicine, from knowing
that all Painters & those people who work in Lead Mines are subject 
to tremors spasms etc. which complaints are owing to the Patient not
being able to contract his Muscles sufficiently, & as the lockjaw is
owing to too great contraction of them, he was in hopes Lead would 
be of use in this disease
Julia Jerusalem aged about 28 years Recd a fracture
of the right Parietal Bone, by a fall on March 1st 1780; a Surgeon
in the Country trepan’d her & she got daily better; but here friends being
unable or unwilling to support her any longer she was sent up to London 
about twelve Miles from town she complained of a stiffness in the Back
part of her head which gradually spread forwards & attacked the Mucles of 
each side of her Neck April 26th she was attacked with a locked Jaw, & 
was taken into St Georges Hospt. her Head being examined a sore
was found about the size of a Crown pied & looked tolerably well; she
complained of violent pain in that side of the Head, & if touched ever 
so slightly it almost threw her into convulsions. April 27 she 
was much worse, & her jaw was fast locked, & the muscles of her Neck
contracted. Mr Hunter saw her & ordered the following 




9
a very good condition’d Pus & not in too great quantity;
the thigh upon the same side was not so [strong] as 
we could wish owing to the strong contraction of the
Muscles which prevented it from being kept in its 
proper situation. the other thigh was perfectly [in????]
the wound continued going on very well untill he was
discharged Augt 23 perfectly cured except on thigh 
being longer than the other




8
June 30th
Wm Forthcombe by a fall from his horse & a [Chariot] running over 
him fractured both thighs, & one of his Legs, in the Leg 
the Tibia protruded about 3 inches through a small wound,
the end of the Bone was very pointed & rough which 
determined Mr Gunning to take that part of it off
which came through the wound – the thighs were 
both set([?]a) the Leg after the Bone was sawed off
was dressed with dry Lint & digestive over all,
about the third day, upon the dressings being removed
there appeared considerable inflammation around 
the edges of the wound which seemed to extend
for a considerable way on each side, fomentations
& Poultice were used; about the sixth day the
inflammation being in a great degree removed it
began to discharge tho’ but in a very small degree
& that not of a good consistence; a Fever which 
had attended him during the whole time was on
the 15th day much abated, & the wound beginning
to put on a more favorable appearance the Bark
was given in considerable quantities, which had a 
very excellent effect, the wound in a few days discharging 






7
ay 20
Jno Cradley, was brought into the Hospital with a fracture
of the Tibia just at the lower extremity, the fracture being
reduced the Leg was put into a stale Beer Poultice,* there was
considerable extravasation, suppose nearly four ounces 
just upon the fractured part in about three days from the 
Accidt there came on very considerable inflammation, & on 
the fourth a Mortification was begun, which continued
increasing for two days, & had spread on each side the Leg 
nearly half way up, he had a very strong quick Pulse
which occasioned him to lose zxii of Blood. he had likewise 
a Glyster administered, which both together seemed to 
have a very good effect, as the mortification soon 
began to abate. about the 10th day after he came in 
the Mortified parts began to slough, & about the 20th 
from his first coming in, the wounds discharged 
an exceeding good Pus & began to cicatrize. he went 
out of the House on July the 30, perfectly well except a 
little stiffness about the Ancle


A very ingenious young gentleman of my acquaintance
informs me that he had seen extravasation of Blood from 
an external injury, let out by Puncture & the parts brought 
together & healed by the first intention, & this with very good
success. We often find very troublesome Symptoms
from extravasation, very often it producing a Compound
from a simple Fracture, & a vast number of other disagreeable 
consequences by this I don’t mean to say, that
I think it would always be the best way to make
Puncture I have since the above was written 
seen leeches applied externally with very good success, & I think
were they oftner used, in inflammations attending bruises etc.
they would be found of very excellent service 


6
March 5 1780
Jno Elliot was brought into the House with a fracture of the 
Humerus near the Articulation, it was bound with a long 
Flannel Roller & the man ordered to keep to his Bed
he went out well the 17 of April
May 31st
Thos Craven came into the House with a Wound of the [Crural]
Artery about mid way from the Groin to the Knee, it was
wounded by catching a Knife between his Legs as it was
falling, the same evening he was examined by Mr Gunning
accompanied with the other Surgeons – the Crural Artery was
found pierced quite through by the Knife & one of the large Veins 
was likewise Wounded. the Artery was carefully dissected away
from the adjacent parts, & a ligature passed above & below, & tyed 
very tight; the wound was dressed with dry Lint & digestive 
over the whole; the Man rested very well by the assistance
of Opiates, that night, a day or two afterwards a slight 
fever attended; on the third day the wound was dressed & 
looked exceeding well, & a Natural warmth was in the Le
it continued in this state discharging good Pus untill
he went out which was 46 days after the Accident, when 
the wound was firmly healed




5
March 1st 1780






4
March 1st 1780
Jno Perry was brought into the house with a fractured leg
both bones were broken about the middle of the Leg, & there was 
a small external wound but no protrusion of the Bones, a small 
tumor appear’d near the wound seeminly containing extravasated
blood, the Eighteen tailed bandage was applied & the wound dressed
superficially, the third day after he came in, he was very feverish
& the Mist Salin cu Nitre was given, & as he had not had any stool
since he came into the House, a Clyster was administered, which 
had the wish’d for effect he continued the Saline mixture & Nitre for three
days at the end of which time the Tumor which had appeared 
burst & discharged a quantity of Pus, it broke into the former
wound which had continued increasing in size untill the Tumor 
broke into it, as the fever had now almost disappeared the
wound began to [wear] a better appearance, & the matter of a 
good consistence this favorable appearance continued for 
some time when the Discharge became very great the Fever
increased & a train of bad Symptoms appeared, about the 
seventeenth day after his receiving the Accident, he became 
delirious, with strong rigors, & on the 22nd day 
he died




3
Jany 24th Fracture of the Humerus
Fredk [Luthit] came to the Hospital with a fracture of the Humerus
the bone was shiver’d into a number of splinters, which were 
plainly perceived to be detached from the main bone.* the part was
bound with a tight roller & Splints. the Man was not then taken into 
the House but order’d to come again on the morning following
25th In the morning when the Man came his arm was violently swell’d
& the lower Amr of a Black Livid Colour, owing to extravasation; the Man
had not had any rest the preceeding night & was then in violent
pain. the Roller & Splints were immediately removed the Arm order’d
to be fomented, & the Poultice with the Stale Beer Poultice; an Opiate
was likewise administered which gave him some little relief, but
he still complained of considerable pain, no Pulsation could be
perceived in the lower Arm nor did the Pulsation return perceptibly of several days;
he was order’d to take the Bark plentifully & a Glyster was given 
the same day with [illegible.] The Discoloration continued for upwards 
of a fortnight & in about three weeks after the Accident the bones 
were united without the assistance of bandage, tho’ not in an 
exact line, in about a month he left his bed & carried is Arm
in a Sling & tho’ so long since the Accident, yet he can’t move
his fingers nor has he any use in the Arm he is now using 
the Flesh Brush with the Pulv. Sinapis to act as a Stimulant, he 
has used it for or five times & says he thinks he receives some 
little benefit from it during the space of a fortnight, there 
was a considerable discharge of Pus, from the Arm, but it was merely 
superficial, owing to the Poultice destroying the [illegible] & raising it into little
Blisters from which the Pus issued this Man I saw about six
months after the accident, but his arm remained in the same state


*I think we may judge from this of the impropriety of applying 
our Bandages too tight at first, as I should suppose all the mischief
was owing to one or more of the Splinters pressing upon the Artery
& stopping the Circulation


2
the following day (which was about three weeks from the time of his
receiving the Accident). Mr Hunter came & examined the Case, which 
done, he opened the Tumor nearly its whole length, within it, was found
contained a vas quantity of Coagulated as well as fluid Blood intermix’d
with Pus, there seemed an universal inclination for bleeding in all’
the small Arteries more especially in one which lay in the very 
direction the [pin] went in, & upon examination it appear’d as tho it
had been wounded by some means or other, as the blood came from it
very freely; Mr Hunter perceiving the general inclination there
was to bleed in the small Arteries applied [dossils] of [Tow] dipt into 
Sp. Terebinth. into the whole Cavity of the Tumor filling the whole
space with the [Tow dipt] in the Spts & over the whole Pledgets of Tow,
with a pretty tight roller over; The man was in very 
great pain for some time afterwards, which was relieved by Opiates;
when the wound was opened three days afterwards, it looked 
exceedingly well & a good conditioned matter seemed to be formed.
it was dressed with the Common digestive Ointment, & Pledget of
Cerat [Epulot], & over the whole a roller as before tho’ not so tight
the Man was ordered to take the Bark the day the Tumor
was opened, which agreed with him very well, his Appetite
being returned which before he took the Bark was very deficient
he went out of the House about a month afterwards 
perfectly well




[?]
Feby 16. 1780
Thos Langford Aged about six & Twenty came into the Hospital
with a large Tumor in the lower extremity of the left Thigh, it was
in length about 8 inches, & in breadth six; about three weeks before
he came into the House a large steel Hat Pin had run into his
thigh at that part, upwards of five Inches, the day after the Accident,
a swelling came on. & he applied a Poultice to it immediately it
was perceived, which in some degree alleviated the pain which before
was very considerable: he continued the Poultice for upwards of a 
fortnight at the end of which time it broke & discharged a vast
quantity of Coagulated & fluid Blood, but the man says there was
not any pus mixed with it; he continued the Poultice for two days
more, & then came into the House, as it was late in the evening
when he came in & the Case not seeming to require immediate attention, it was
not examined until the next morning, upon taking off the 
Poultice a prodigious quantity of blood intermixed with pus
issued from out of the Orifice (which had appeared a few days
before) it seemed to issue out at every vibration of the Artery
which led me to suppose that one of the Branches
of the Femoral artery had been wounded [?] in this I after 
wards found I was not mistaken. it was dressed superficially 
only, with a Poultice over the whole, as [?] H. whose Case it was
did not come to the Hospital that day

















Shaw Jno  5




Penny John  4








Langford Thos  [?] 
[Lutfit] Fred  3
Locked Jaw Case of  10










[Forthcombe] Wm  (8)


Elliot Jno  6




[Cravon] Thos  6
[Crudby] Jno  7












T. Tomlinson