Jno L Price John L Price Lectures on Surgery Delivered by B. W. Dudley MD In simple sprains of the joints, rest is the cure Light [sprea???] The left testicle hangs lower than the right, has a longer spermatic cord of course & is the [illegible] of varicocele Lexington Novr 24th 1822. Transylvania University Medical Department A concise digest from Murrays Materia Medica appertaining particularly to the practical use of numerous articles in the materia medica By John L. Price Narcotics. Alkohol Ether Camphor Papaver somniferum Hyoscannus Niger Attropa Belladony Aconitum Napellus Conitum Muculatum Digitalis [Perpared] Nicotiana Tabacum [Lactura] Vivosa Datura Stramonium Rhododendron Chrysanthum Rus Toxicodendron Arnica Montana Humulus Lupulus Strychnae Nux Vomica Prunus Lauro-Cerasus 1st Alkohol, Ardent Spirits Spirit of wine (it is a compound of carbone hydrogen & oxygen) Alkohol is a powerful & diffusible stimulant. Taken in a moderate quantity, it almost immediately increases the force of the circulation, communicate a greater degree of muscular vigour, & excites exhilaration of mind: these gradually subside, and are followed by proportional languor. If the quantity is now considerable, its exciting effects are more quickly produced, and are follwd, by intoxication, temporary delirium, and stupor, and in a large dose it occasions death, with scarcely any symptom of previous excitement. Alkohol in its pure state can scarcely be said to be employed in medicine. The action of wine on the system, though analogous to that of alkohol, is not precisely alike; its stimulant operation appears to be less sudden and more durable; & hence it can be employed with more advantage as a tonic. It is as a tonic indeed, rather than as a narcotic, that wine is administered. Its chief medical application is in the treatment of fevers of the typhoid type, in which it is employed to support the strength of the system, & to obviate the symptoms arising from debility. The quantity in which it is given is altogether dependant on the state of the disease; the object to be attained is that of supporting the strength of the system until the disease has run its course; etc. advantage is always drived from wine, when it renders the pulse more slow & firm, when the recurrence of delirium is prevented; when irritation is lessened, & sleep induced. the pulse is quickened, & the countenance becomes flushd; if it excites thirst, increase the heat of the body, & occasions restlessness or delirium, it is obviously injurious; & the dose must be either diminished, or its uses altogether suspended. From the immoderate & [illegible] continued use of vinous & spiritous liquors, many diseases derive their origin; as dyspepsia, hypochondriasis, visceral obstructions, chronic inflamation of the liver, & gout morbid states probably arise either from the increased action it excites, giving rise to organic derangements, or from the exhaustion of power, general or local, produced by stimulant operation unnecessarily excited or too long continued. Ether. Asphyxia A state in which the heart and arteries cannot be felt to pulsate Surgery Doctr BW. Dudley Decr 11th 1822 White swelling, in this disease the treatment is in its various species the same after the the reduction of the inflamatory symptoms, the blisters, seatons, ishues will cure. Fracture of tibia is treated by the application of the many [illegible], bandage, & may apply a simi cilindrical splint to prevent the approximation of the tibia to the fibula, prevent inflamation by purging, low diet, & rest. Fracturs of the rotula. In this event the patient is preventd, from walking, with a displacement of the upper fragment of the rotula some considerable distance upon the front surface of the thigh, & in order to trial this fracture for the purpose of its union by oscific matter the two fragments must be approximated, & confined by means of a bandage applied around the knee in form of a figer 8, keeping the leg extended & perfectly still. Rupture of the ligament attached to the rotula treated in similar manner. & apply a bandage from to too upward to prevent oedamatous swelling Displacements of the capsular ligament of the knee may be reducd after you ascertain its existence by a pain a twiching in the knee etc. to reduce this displacement you will put your patient upon a table and flex & extend the leg upon the thigh particularly untill you are convincd of the existance of displacement then flex the leg powerfully upon the [thigh] & at the same time place you left hand in the ham forcing up the head of the tibia upon the head of the femoris, thereby producing the reduction desired. Your patient is immediately relived Dislocations of ancle joint. Fractures of this joint is in four fold, forward, bacward, & to the right & lef In the two last species is necessarily a fracture of the maleolus of the tibia or fibula, not so with the other species, In compound fractures of this joint attended with fracture of the maleolus a cure may be expected without disfiguration by placing the parts in perfect apposition, securing by the stich the lacerated skin, applying the roler, fracture bone, and rest. Excision of the metatarsal bones of the little toe & the toe next to it. as performd by Dr BW Dudley upon Mr Walker Make an incision, commensing at the root of the little toe & extend it longitudinally to the tubercle of the oscuboides. then dissect the integuments, which consists of a portion of the sole of the foot. untill you expose the two metatarsal bones their full length, then dissect up the skin & cellular substance above, so as to expose the two metatarsal bones, & then [excect] them by passing the knife between the roots of the little toe & the one next to it, & between the two metatarsal bones & the oscuboides, then takeing out the bones draw the integuments together & [confind] them by means of adhesive strops & union taks place in course of five or six days by first intention Oscific matter deposited in the knee joint is a very painful disease, it may ascertained by the touch You are to effect a cure of this species of disease of the knee by an excect of the bony matter, takeing care not to cut into the capsular ligament; making an incision through the skin after drawing it tight upon the knee, then letting it releve to its proper position January 14th 1823 Dr Dudley. On the ligaments of the joints of hip, knee etc. Dr Dudley Jany 15th 1823 Diseases of Testicle. Varicocele is an enlargement of the veins It is to be distinguished from hernea by laying the patient upon his back, elevate his pelvis & flex his legs & raise the testicle & reduce the [supp??] hernia & ketch hold of the cord, & presently you will see the hernia return On the back of part of the testicle the veins will present that bluish appearance common the varicocele of the leg or any other part We can do nothing in varicocele but to use the T bandage so as to suspend the testicles It is distinguished from hernean by the circumstance of the enlargement returning after its reduction Chimney Sweeper Cancer. This is not common to our country & is incurable. Nervous irritation of the testicle, This disease appears in one part of the day to be dropsy & in the same day it appears as if it was under a state of [illegible] inflamation, & at another part of the day you would think no thing even the matter, This diseased is nothing more than the result of a general affection, seating itself upon a local part You will confine your patients to a [illegible], milk diet, [illegible] etc. apply the T bandage, etc. locate permanent excitement upon the small of the back, by seaton & the red pepper poultice Dr Dudley Jany 16th 1823 Heart & Lungs. In a midway point between [illegible] & [vertebra] of the back we find the mediastanum, which is made up of the two pleura & divide the left from the right lung The lungs are made up of three loabs of the right & two loabs of the left side. The trachea leads to the lungs & is communicates with the bronchia or [air cels] of the lungs. Then there is a large artery which comes from the heart & about one inch from the body of the heart it divides & one goes to the right & the other to the left lung Then comes the 4 pulmonary runs which carry the blood to the left side of the heart What do compose the lungs? nothing but a portion of muscular fibre & substance which [illegible] artery to the bronchial [??mification], & [illegible] to arteries In [illegible] state of inspiration we find the lungs as high up as the 3 or 4th [illegible] [illegible] & in expiration as low down as the 8 or 9th In case of the passage of a ball through the lungs you bind up the chest which will stop the hemorrhage & a wounded lungs will heal but about the 6 or 8th day a fever comes on of a low grade of which the patient dies & if we open him you will find a quantity of blood in the chest in a state of putrefaction. The heart is enveloped by the pericardium, the external coat of which is a reflection of the pleura The heart is found as the center of the breasts & seconds obliquely. It is made up of the right & left auricle, linus venosus of the right & left side, which is only so much of auricles as in [found] immediately in the [center] of the two auricles right & left ventricles. The right ventricle for the [septunic] circulation; & the left is for the pulmonary circulation The heart in man is made up entirely of muscular fibre, the fibres running from the base to the open the vena cava assending & the vena cava [illegible] unite in the linus venosus In the right auricle of the heart we find the semi luna valve, tuberculum [illegible] Dudley Jany 17th 1823 the aorta blood from passing from the left [ventral] [illegible] Mitral valves. 2. closeing the left auricle, & preventing the [illegible] valves 3 at the mouth of the aorta Corda tardinea. [illegible] [illegible] musculi pectinate tricuspid valves of the right side of the heart is the same of that of the mitrals of the left ventricle. Jon L Price Foetal circulation. The blood of the right side of the heart finds a direct [illegible] from the right to the left side of the heart by two openings 1st through the foramen ovale & 2d [illegible] the ductus arteriea osus through the foramen or [illegible] into the left side & through ductus [arterios?] into the abdominal aorta from thence into the whole system, so much of the blood as passes into the left ventricle finds its way into the assending aorta through the ateriosis from the [illegible] into the superior extremities Dudley Jany 18th 1823 The first malformation of the heart is where the aorta arises equally form both ventricles of the heart, 2d is when the ductus ateriosis together with the foramen ovula remains open (or blue boy) the blood not [illegible] any change in the lungs 3 is whether is a [illegible] opening between the ventricles 4th is the partial [illegible] of the pulmonary artery 5 is when the heart is embeded in the liver 6th is when The effect of all those diseases of the heart is defective arterialization of the blood If they run then with [illegible] (Corvesart on Diseases of the Heart) Abstain from strong diet, drink, & exercise Organic affections of the heart [illegible] Uniform dilation, or anurism of the heart diminution in the size of heart & change in the muscular structure of the heart Oscification of the coronary arteries. Aneurism of the aorta as it emerges for the [heart] [accent] & chronic inflamation of the heart Pulse from its usual beats [illegible] to 30, 15 & 10 [illegible] was full but oedematous in this situation he lived several years & [illegible] the cavities of the heart were equally diluted without any [illegible] thick in the walls of the heart Heart & arteries equals [illegible] pale countenance, spitting blood, extremely oedematous pain etc. & upon dissection the heart was found to be very much incresd, in its muscularity with hard, strong, full & [illegible] [illegible] & [illegible]? Pulse irregular & frequent, syncope, laborious breathing, vomiting, pain the pericardium, a discharge of blood is a uniform symptom Oppression in the chest, syncope, with slow tense cordlike pulse with great increase in the left ventricle & a great increase in the muscularity of the right ventricle It is incurable, but by great temperance & restriction in diet, drink, etc. the death of the patient may be prolongd Chronic inflamation is [illegible] sometimes to simple dilutations of the heart now the pulse becomes greatly increasd to for 125, or 300 & the patient dies or anurism of the heart. Inflamation of the heart & pericardium A [small] frequent [illegible] pulse, a sallow bloated expression of the countenance, [acieut] pain in the pelvis, kidneys with retention of urine comatose, incoherent muttering, died This was a case of inflamation of the heart [illegible] cough, [illegible] (lady in gestation) pains in the kidney, pain it its bowles, tenesmus, vomiting pain in the brest, pain in the pelvis delirium & death (Inflamation of the heart) Diarrhoea, small frequent tense & cord like pulse, cough, pain in the pelvis, incapacity to run upstairs, 120, to 160 in minutes, in [illegible] Pain in the breast, stomach & bowels, anxiety in countenance, stricture in the bowels from [illegible], considerable difficulty in breathing The heart is sometimes reducd in size in consequence of low fever which cant be curd Dr Caldwell, Feby 1st 1823. [illegible] On cathartics. These remedies produce an evacuation from the intestines by exciting secretion in the parts by creating a new disease which nature can cure, in place of one which nature can not cure Cathartics are divided into laxatives, purgatives, & drastic purgatives Each having a specific action independent of the effect it has in removing the alvine matter, some purgatives not mildly others not producing nausea & [illegible] sickness The [illegible] cathartics are of importance next to emetics to the physician The first effect these cathartics have is to evaculate the intestines & sometimes the stomach [illegible] Administer cathartics when the stomach is not full for then it acts better, quicker & is not so apt to be rejected If you wish to excite the sickness of the liver, mercurial cathartics are best If you wish to [illegible] & water in case of dropsy, cream of tart & jalap are the best cathartics; If you wish to make an impression on the uterus. give those cathartics which act more especially upon the rectum Drastic cathartics act best when combined with some milk purgative. When you have a chronic disease such as chronic diarrhoea chronic purgatives must be used Purgatives are useful in all febrile affections. As it depends on congestion In pleurisy [prepneumonic] [purgation] are useful. In all abdominal diseases purgatives are useful, cephalic affections call for purgatives in all instances In remittent fevers purgatives are of more importance than in intermittents & more so in typhus than in either. In pneumonia [illegible] purging were of importance in the late epidemic of the disease Typus fever is seated in the mucous membrane of the stomach prima via (not in the nerves) [purge] while you stimulate in this disease In fevers of the [illegible] another [illegible] kind Small pox etc. In small pox the greatest danger is in the secondary fever you guard against this by purging & cool air scarlitena araginosa, purging & bleeding prevent this disease from terminating in dropsy Calomel with [illegible] kind of purgatives wise to produce a relaxation of the system Squill, red & white vinegar of [squill] oxymel of squill etc. are oficinal, preperations which puke 8 or 10 gr in powder is a dose It is given to throw up mucous Sulphate of copper or blue vitriol, is a puke of a severe kind the dose from 3 to 5 grs Sub sulphate of mercury pukes, combined with squills they are efficatious in dropsies Squils are good remedies in dropsies Dose of S.L. [illegible] is from 6 to 8 grs is a puke Zinc, or sub sulphate of [illegible] is a very active emetic & operates very quick, & is given to evacuate poisons, you will have to repeat the dose perhaps The dose is from 8 to 10 grs. but is poison from 10 to 20, 30 40 or even 50 or 60 grs have been given to produce immediate effect In Colicus [illegible] the best remedy is salivation. Cholia [Pictonum] Tart emet is a valuable remedy in combination with calomel to relieve the congestion of the liver etc. Tart emetic does much in throwing out the eruption in small pox measles, scarlatina anginosa etc. Urticaria & all eruptive diseases, whose seat is in the stomach. Tart, & mercury where chronic eruptions of the skin. In leprocy tart is an excellent remedy. Herpes or ring worms are relivd by emetics Tart given in injection evacuats the whole intestines when no other remedy would purge Use always about 4 times the amt for injection that you would in the common way Active emetics, nicotiana tobacum or tobacco, it is an emetic, narcotic, diuretics, & produces evacuations from the bowels It is the most violent emetic which may be used to evacuate the stomach when poison has been taken. In strangulated hernia, that cant be reducd, by the [illegible] tobacco has been given by injection & other Dr Caldwell Jany 25th 1823 Materia Medica Of Antimony. Hoffman, Cullen & Fordyce introducd antimony extensively into the [illegible] & no person has objected to it since then. Antimony is a medicine that acts, quickly & powerfully It is puked, purged, diuretic, [illegible] expectorant & absorbant If you [illegible] [illegible] to puke give it in a full dose. The antimonial wine is a very pleasant preperation [illegible] the wine equal to 1 gr of the antimony, according to the London pharmacopia, but 1 [illegible] of the wine, is equal to 1 gr of tart emc according to the Edinbuh, & American pharmacopiae Antimony is the form of tartrate of antimony is a valuable remedy in all febrile diseases. It has a specific power independent of its pukeing & nauseating qualties What every medicine is used & acts, [illegible] as a specific remedy tartar & opii, acts as a diaphoretic, tart & nitre acts upon the kidneys Tart emetic in union with salt, are useful in many febrile affetions In all abdominal disease the [illegible] to introduce his hand [illegible] obtain the [feet]. Be guarded not your [opium] so as to relase [illegible] or the uterus will not contract after delivery our hemorhage will kill the patient. In [illegible] and other [illegible] presentation as not [illegible] the presenting part until the feet are obtained makes all efforts during the absence of pain. Dr Caldwells Jany 22nd 1823 The ovaria is the seat of impregnation Foetus’ have been found in the ovaria; fetus have also been found in the fallopian tubes [remote] stimulation is as efficient as proximate stimulation is Every vital action is the the result of stimulation. The embryo is a secretion, & the result of specific stimulation in the higher orders of animals Foecundation is a sympathetic process In hand presentation, the same precaution precaution should be taken previous in effort to lure the child. In hand shoulder, hip, knee and other mal presentation, since the time of Ambros [Pari???] the practice of fetching down the [feet] another [preceding] to delivery has been concidered the best practice it is more than proper practice. To effect this object we must, if the membranes are entire [illegible] than and introduce the hand & by slow but reserving efforts get one or both feet and [illegible] them [illegible] & but one is attained, retain it and [illegible] down the other in the same manner. In a [hand] [illegible] and the head is in the right or left illium we should wait the efforts of nature to produce a spontaneous evolution. To facilitate this evolution gives [illegible] [enurias], opiates in moderate quantities to relase the uterus sufficiently to [illegible] Dr Richardson Jany 22nd 1823. The first consideration in [illegible] [illegible] is to [illegible] the feet and give such direction to the child as well directs the hips, shoulders and occipital in the most favourable manner the occiput to the and then to the arch of the pubis. In breach, another mal presentation of the inferior extremities the first object is to obtain the feet and the proceed as above The [illegible] will enable us to distinguish a shoulder from a breach presentation without much difficulty The organs of generations will in all cases give an evidence of it be breach presentation. There are cases in which the hands of two different children will present those are very rare cases. The situation of the feet in the uterus should be ascertained by examining the presentation, before the hand is introduced to turn the child 2nd that the absorbents take the [illegible] [illegible] and carry it to the ovum. 3 4 5 The [ostinse] is never so large as to prevent the [neal] [penio] or to receive the [illegible] it [progistil] force. Again the canal is not directly continuous, nor is its in a [illegible] with the [acids] of the vagina. Again the [illegible] is the ostinse fit each other so closely as to render it [illegible] & there is no cavity in the body of the uterus in a natural states And if the [illegible] [masculinum] was in the body of the [uterus] it the could not possibly make its way through the fallopian [illegible] to the ovaria. C. Caldwell M.D. Jany 21st 1823. Lecture 2d on generation. In generation some facts settled others not so. The ovaries being the germ or seed of the future being is a fact settled. After coition and conception it is known that near more of those ovum [illegible] remove, after processes in it similar to the process in an abscess terminating in rupture and the ovum is taken up by the fallopian tube. The rudiments of the foetus have by emaciation been found in the ovaria. It has also been found in the fallopian tube which are evidence of the [set] of concession being in the ovaries. The change in the ovaria is produced by the stimulus of [illegible] [illegible]: all these facts are agreed on ‘ by all physiologists at the present age Some have supposed the [illegible] [illegible] was carried to the ovaria unchanged and by [illegible] with the [illegible] produce pregnancy. In chronic diarhoea 2 or 3 gr ippecac in the morning & an anodyne in the evening. In dyspepsia ippecac is the best emetic but when the [liver] is affected the tar eme is bitter, In asthma & ippecac is the [illegible] emetic, from three to five grs every morning between the paroxysm In [illegible] ippecac combined with opii in small dose, relives the cough, acts on the skin & reduces the inflamation of the pleura. Dr Brown Jany 22d 1823. Peritoneal lining the internal [parrietes] of the abdomen, & on the vicera, [perenchemar] of the vicera themselves, & the mucous membrane lineing the inside of the intestinal canall These inflamation of these different seats are modified In peritoneal inflamation pain is felt upon the slightest pressure Antiphlogistic required should be strictly adhered to this disease Blisters are not to be used in the early stage of this disease Tubercular accretions at the peritoneum (calld negro poison) resulting from a disease of the lymphatic system. was absorbed Dr Caldwell does not believe the that poison or nutrition is or can be taken into the system by cutaneous absorption Materia Medica Emetics are useful in the bite of poisonous serpents. They are useful in cases of luxations of joints, they are also useful in nauseating doses to produce relaxation in the reduction of hernea Ippecac is a very mild emetic but it acts more quickly than tar. em. The combination of piiecac & tart emet produces a better & quicker remedy that with ippecac or tar emetic, seperates, it operates from 1 grs to ½ [illegible] but the most common dose is from xv to xx grs. In uterine hemorrhage an injection of sac sat opii dissolvd, in gum arabic is a valuable remedy In dysentery often having [illegible] proper evacuation. [illegible] a combination ipecac, calomel & opii It is a congestion of the mucous membrane [turning] the the alimentary canal carbonic acid gas may be disengaged by all the other acids Dr Caldwell Jany 18th 1823. Absorption contd When tumours are carried away by resolution they are carried away by the action of the absorbants equible pressured of a gentle kind excite the absorbants to action It is by exciting the action of the absorbants that you cure dropsies except when you tap, ulceration is an action of the absorbants, suppuration is a morbid secretion & the cavity in which [illegible] is found is formed by absorbants. Humidity is sayed to be absorbed from without through the skin for instance if you are thirsty, thirst is very much allayed by being [caught] [into] rain All febrile poison were though to be absorbd, [illegible] the powers of the skin, but Dr [Currier] doubted this, & when he began to doubt he began to experiment to ascertain the fact, He bathed & his friends bathed in the warm bath & after weighing upon coming out of the bath he always found that he never gain any weight He also bathed a patient in milk & found that nothing Dr Blythe Jany 17th 1823. Carbonic acid gas may be very readily obtained from [illegible] [tubs] simply by pouring a bottle of water into the tubs Carbon is the base of charcole. Charcole has the power of preventing putrefaction (Carbonic acid gas will prevent putrefaction) There is a small quantity of carbonic acid gas in the atmosphere, which Dr Blythe thinks seises upon the particls of putresent matter that is continualy going on from decomposition, breathing etc. & keeps the atmosphere from becoming disagreably impregnated with noctious vapour etc. Vegetabls during night gives out carbonic acid gas which unites with oxygen But in the day time vegetable give out oxygen & retain hydrogen Take carbonic lime sulphuric acid mix, & carbonic acid gas is [evolved.] Chalk [Lackeri??m] [illegible] Vinous [illegible] Ascites [illegible] [Colo???] [illegible] Putrid In all these form [illegible] carbonic [acid] gas is an agent Sugar analised is found to be composed hydrogen 8[illegible] 100 Oxygen 64 Carbon 28 100 Dr Caldwell, Jany 17th 1823. Absorption. This is a very universal function it may be said to be more so than secretion & nutrition, because it counterposes both the formation of [illegible] arises from a want of balance between nutrition & secretion, In all dropsies this is more secretory than absorption & where there is more absorption than secretion One of two things must be the consequence emaciation, or ulceration The mouths of the absorbents are [illegible] the body, entirely, for if it was not the case the whole of the body would not be emaciated by absorption What ever part is nourished, or changed must necessarily have absorbents Without absorption nutrition could no in a healthy state go on The absorption of the chyle from the alimentary canal is the first act of absorption Absorption is necessary to growth of animal growth JMC Irwin 1830 2dly by [illegible] a quantity of cold water in [illegible] [illegible] is to the place where it is found Dr Brown Jany 17th 1823. Diseases of the Heart, [R??] Corvesart Bronchitis. etc. Dr Richardson Jany 17th 1823 Dr Blythe. Jany 16th 1822. On Carbon. Carbone is a simple substance & is one of the most generally diffused substances in nature Carbonic acid gas is colourless, extinguishes combustion, [deleterious] to animal life, exerts a powerful effect on living vegetables, it has a pungent taste [illegible] without combining with oxygen, but if left together the carbonic acid gas subsides This gas unites with water slowly It is remarkable that water & carbonic acid gas unites when severly agitated, but this function is very easily broken It precipitate [illegible] from a solution of water Of all gases it is the most universal, & is found in their [illegible] state, 1st In the form of gas, 2d is a state of [mixture] & 3d [In] a state of combination as in [illegible]. It is found in abundance in two situation in which physicians engaged against. 1st in the bottom of wells & in low cellers This carbonic acid gas may be rendered untruthful by 2 ways 1st by presenting a quantity of lime to [places] where it is found, the gas will combine with the lime When the chemical doctrine prevented, the secretions were formd chemically At another time the secretion was formed by a putrefactive process If secretion does not [illegible] by mechanics or chemistry etc. by what process is secretion carried [illegible]? I answer by a vital organic process or living organic action upon the blood Nutrition. Nutrition is very nearly [illegible] to secretion for the first process of [illegible] or a secretory one for if you wish to nourish a bone, particles of oscific [illegible] must first be secreted, & deposited to the part needing such nutrition. All nutrition comes from the blood, hence from it nutrition must be secreted from it & deposited to the various parts of the body Nutrition is the result of a peculiar vital organization for destroy the organization of the parts & nutrition ceases. from place to place External cavities of the body are lined with a mucous membrane, & the internal cavity are lined with a serous membrane The aqueous humor of the eyes, of the ears are a secretion, the bill, the liquor pancreaticis, saliva, mucous of the intestines, lungs, semen masculinum menses, generation, & in fact it is but necessary to name the various secretions to convince you of the importance of secretion hence it is important to understand the above as well as the various other secretions of the body Though we do not know what effect the secretion of urine from the arterial blood, the secretion of bile, from the blood, & the various other secretions from the blood, yet it is certainly true that the various secretions have a beneficial effect to the whole system Philosophy or modus operandi of secretion AT all times & in every cavity the doctrine of secretion have been [illegible] with the doctrine of the schools or in other words when the mechanical doctrine or philosophy prevailed, it was stated that the venous secretion existed formally in the blood Rhamsbotham & Merryman says that the placenta should be detached by the hand, by which the happiest effects result Dr Caldwell, & [Pindle] both of whom have had an external practice in obstetric, say they always detached the placenta with the best & most successful effects In a majority of cases detachment of the placenta will be correct, yet there are cases when a detachment would be nothing more than to occasion a hemorrhage which will destroy your patient Hence the segacity of the practitioner is imperiously demanded to [illegible] & distinguish between cases that admit of detachment & those cases where detachment would produce the most fatal effects. Dr Caldwell Jany 16th 1823 Secretion continued. The effects of secretion within the joint is to [grive] moisture & lubrication to the joints, to prevent disease inflammation & consequently a permanent inability to move the joint which would prevent the animals from transporting himself Dr Richardson Jany 16th 1823. After the delivery of the child the state & condition of the uterus should be ascertained by applying the hand to the abdomen to know whether their exists another child or not & to induce the uterus to contract for the purpose of throwing off the placenta It is in the third stage of labour which consists is the delivery or expulsion of the placenta, that the principle danger exists to parturient women The practitioner should never leave his patient untill the delivery of the placentas. He should examine the contractile power of the uterus, to ascertain whether it is capable of throwing off the placenta A want of contraction in the uterus to detach the placenta, is one cause of the relation of the placenta & of haemorrhage after delivery By turning the cord round the finger & pulling it gently when the uterus is lax & [fluid] will sometimes stimulate the uterus to throw the placenta into the cavity of the vagina, thereby facilitating the contraction of the uterus, which will prevent hemorrhage [illegible] says that the hand should be introduced into the uterus for no other purpose but that of making the uterus contract [the] diagnostic symptoms of pericarditis & [pleuritis] are sometimes nearly the same no [dis??????] arise from such a mistake & the treatment is the same is organic diseases of the heart the beats of the heart is very loud so much so that it may be heard distinctly without the use of any instrument In pericarditis from the first the patient has [peculiar] anxious expression, & paleness with severe pain (Corvescart upon the Heart) In chronic bronchitis When a pain in the forehead, bleeding is necessary antimonials, & the bowels should be kept loose inflamation & a spasmodic affection of the throat etc. The most usual exciting cause of croup is cold attended with moisture Croup is thought to be contagious The treatment of croup is divided into to Bleeding extensively, the tart emetic; then [calo???], the warm bath, & after the system is reduced to a blister to the throat which will generally give relief Dr Brown says that the use of cold water to the throat, feet & hands in cold weather, by habituating the children to the impression of cold, is a very great preventative to the croup Pericarditis. This disease is attended with an accute rheumatism, & the beats of the heart may be heard by rolling a quire of paper & placing one end against the [stu???] & the other to the ear The pulse is hard & quick the tong is furd, with palpitation of the heart, a peculiar anxious expression of the countenace etc. Dr Brown Jany 16th 1823 Laringitis. This is the disease Dr Brown thinks that Gen Washington died with instead of the croup In laringitis there is most generally an accute pain felt by touching the thyroyd gland & is attend with the expectoration of a thick viscid phlegm the duration of this disease is generally about four days. This disease is treated by extensive blood letting, both general & local and Croups or inflamation of the mucous membrane of the throat. (Dr Farier on croup) This disease is characterised by inflamation & a very peculiar sonorous sound. The [illegible] of adults to croup is owing to some [illegible] that the mucous membrane undergoes The symptoms of this disease is of the character of catarrh or cold, & a cough with tenacity of blood During menstruation there is an unusual fluxion of blood to the uterus & the [illegible] of the other power of the system are determined to the uterus. There is a chilliness, heat flushing, the systems do not resist cold at the humidity at this time, as well as it do at other times because of the diminished energies of the whole system except the uterus In women there is a determination of blood to the uterus in every lunar month for the purpose of [renovating] the powers of procreation, the secretions attend [illegible] the influx of blood to the uterus is an evidence of health of the generative system & of the susceptibility of the female to impregnation Dr Blythe Jany 15th 1823 ([illegible]) There are three things with which water has to contend, to wit: atmospheric [air], sulphuric acid & water is the standard of weight for two things, viz solids & fluids Rain water contains atmospheric air carbonate of lime etc. Snow water is destitute of atmospheric air body No officious attempts should be made to extract the placenta Dr Caldwell Jany 15th 1823 (On Secretion) By secretion is ment the production of a fluid from the blood b y a vital organic action, which fluid [does] not exist in the blood in a formal state Secretion is a creative process The elements of the fluid secreted exists in the blood unquestionably The passions of the mind affect the actions of the glands. Glands act vicariously upon each other The brain is thought to be a great gland The glands recive a much greater amt of [illegible] than is necessary for its own nourishment, & perhaps acts upon the blood in some way for the benefit of the rest of the system The [illegible] glands of a peculiar kind & are of infinite importance for they unquestionably secrete the elements of the foetus in utero Menstruation is a secretion performed by the uterus of a sanguinous colour it is not vital, it does not coagulate, it does not smell, or taste like blood nor has it the [illegible] her [illegible] A handkerchief should be [open] around the thorax & tied to the bed post so as to keep the patient still, with the feet against something firm to give here rest No attempts should be made on the part of the practitioner to dilute the [illegible], not to rupture the membranes, but to left to the contractile power of the uterus itself The practitioner should be supplied with a pair of scissors, & ligature, & napkin The napkin to press upon the perineum to prevent its laceration, & as soon as he [recives] the child & the pulsation in the cord ceases & the child breathes freely & cries he should apply the ligature & tie it within two or three inches of the navel & [then] at the [cord??] Let no entreaties induce you, in natural labour to attempt to facilitate the passage of the head of the child by any efforts with your hand, nor the the body of the child, after the head is delivered, For with in a few minuits after the head is delivered the uterus will by it own power & which will be ever true to its purpose expels the this disease attacks most frequently young & delicate females The antiphlogistic plan should be adopted in this disease, take care to bleed for effect Dr Richardson Jany 15th 1823. When calld, to a lying in chamber, it will become the duty of the physician to direct & manage his patient with great delicacy and respect for her modesty The position of the patients are various during the period of delivery Some are delivered, while setting upon the lap of some friend others remain in [illegible] or upon a cot, or couch prepared for that [illegible] other again sit upon a chair The first duty of a physician when call to a female in labour, is to enquire into the state of the bowels & the [tention] of the bladder & [if] necessary the bowels should evaluated, & the urine [illegible] off In the second stage of parturition the patient should be put to bed, layed upon the left side with the extremities some what fluid, with a pillow or some other substance placed below Dr Brown Jany 15th 1823. [??ulent] sore eyes, or Egyptian ophthalmia. In this disease there is always a high degree of inflamation & bleeding should be carried to the fainting point, from a large orifice, purging; puking, & the whole of the antiphlogistic plan should be vigorously persisted in, until the inflamatory symptoms have subsided, with the exception of warm colyria topically. Influensas. In this disease old people [illegible] affected with catarhas Sinalis, suffer severely from its attacts This disease raged with some violence in this country last year. The lancet should be used with great freedom in influensa, & the whole of the antiphlogistic regimen should be adopted etc. etc. Cynanche Toncillaris. This is a febrile affection of the mucous membrane lineing the toncills, with swelling, etc. the inflamation attends frequently to the eustacian tube of [illegible] deafness = this disease ends in suppuration frequently sometimes requires exciction of the tonsils Written when at Lexington attending the school at Transylvania University [illegible] oxyde of [illegible] [illegible] muriatic [illegible] If you [have] acid [illegible] which [illegible] [illegible] [illegible] oxygen [1] [illegible] of [illegible] 2 [illegible] of [illegible] 3 [cloral] [acid] 4 per [cloric] [acid] [illegible] [illegible] we find the [col???] [Some] [illegible] [illegible] the mouth of the right in [illegible] [illegible] [illegible] [illegible] you find the fossa ovalis, [appears] [illegible] of eustachius & then the [illegible] [illegible] In the [illegible] the heart the mitral valve present [illegible] [regurgitating] into the [aorta]