Bartons Lectures
By Theory of [Audioeau] is meant that part
of [Science] called Institutes of Medicine.
It is divided into Physiology, Pathology, &
Therapeutics.
Physiolgy is the Natural History of the Human
[body] or the theory of the functions in a
[state] of health.
Pathology is the history of the functions of the
body in a diseased state.
Therapeutics is that part of Medicine
which treats of the nature of [action] of
medicines in the cure of diseases
Therapeutics
This branch of the Institutes has been more
[neglected] than any other. One of the [other]
objects is to inquire what hase been the means
which have been employed for the cure of
diseases. Every nation passes some means
for the cure of their complaints. & often
distant nations employ the same [remedy]
for the same disease though [entirely]

[acquainted] with each other.
[Their] is considerable resemblance between the
habits of different plants. [crossed out] [crossed out]
[affinity]. In most instances where this
happens there is a resemblance in thier
medical properties. It is still more certain
that when two plants agree in Botanical
affinity their medical properties are very
nearly allied. There are however several
important exceptions to this. Medicines that
agree in their sensible qualities usually do
also in their medicinal properties but this
rule has some exceptions.
The palid Colour has been considered an
indication of mildness in vegetables; the
White of a sweetness. Red of acidity &c
yellow of Bitterness, Green of Acridity, & the
Black of something ungrateful. This doctrin
is true to a certain extent but it has many
exceptions.
[Experiments] on animals has been a source of
information, but it is found that the
effects of some medicines on Animals

it very fast. Rats & Mice have long [wasted]
on it. Swallows are [suppo?ti?] on it in a
great degree. The Canary Bird cannot
lay its eggs without having a portion of
Lime. Other earth will not answer. It is
since
readily absorbed into the System, About 70 years
in a history of the [orowaks] it is stated that
the Inhabitants consume large quantities of
Calcarious Earth, Humbolt has since confirmed
this statement.
Carbou I suppose is nutritive to the Human
system; it is found to be highly so to vegetables
Light I do not suppose to directly [nutritive]
but it is highly important to the growth &
beauty of vegetables. We however want facts
to determine how far it is necessary to the
support of the Human System.
The mode of applying and the operation of Remedies
are the particular objects of the Therpeutics.
Light has been considered;


By Condiments we do not consider substances
entirely fitted to nourish the body but are kind
of Stimulants introduced into food of Man by habit.
They are absolutely necessary to our existence when
once we have used them. Among them is
the Common Salt, which is the most useful &
harmless of them. It is used among all nations.
Mustard, Horse Radish, Pepper &c are more or less
necessary to our tables for the assistance of digestion.
Condiments are articles between Medicines &
Aliments.
Class 1st Astringents.
Most Authours have employed this class, but it
will be seen that it might be abolished & the
articles put under the class of Tonics.
Cullen suppose they act mechanically, but this
is inconsistent with my opinion but I not very
confident of giving you a better explination of
their action. They evidently restore strength to the
solids of the body when debilitated. Their operation
on dead matter cannot explain their effects on
the living system. When a Hide is tanned

5
are very different when given to a Human
being.
[Experience] is another very important [source]
of information.
The arraingments of the [articles] of the Materia
Medica are very important. The Alphabetical
method is very improper. The Sensible
properties cannot be employed to arrainge
them. Botanical systems have been used
but this is also inadaquate in very many
cases. The Botanical Affinity has also been
used and with considerable advantage
but still it [affords] important exceptions.
Doct Darwins supposes that medicines act
specifically; this system will be examined
hereafter. Doct Cullen,s system will be
adapted with some alterations & additions
and also Duncan & Gregory,s will often be
resorted to.
By a Remedy we mean any thing that is
capable of producing a salutary change on
the Human Body by a proper application

By Aliments are meant those substance which
are fitted to nourish the Human Body. They
are numerous; drawn from the Animal, vegitable
& mineral kingdoms. Man can support himself
with a greater variety of substance than any
other Animal; yet there are bounds to the
principles of these substance which afford the
nourishment. A large quantity of acid is daily
taken into the Stomach, but no acid is found
in the fluids of the Body. It must be assimilated
to them. Cullen supposed a fermentation of
an aceteous kind goes on in the Stomach
in the process of digestion, which prevents
the fluids from running into a putrescent.
state. This is incorrect; Man may be
supported on animal food without a
tendency to a putrescent state. A vegetable
diet he supposed necessary to prevent this
state of the fluids. He also supposed
the Mineral acids incapable of correcting or
preventing putrescency; but they will cure
the Scurvy by proper dilution, as I have
experienced in the use of diluted Muriatic acid.

3.
Sugar is next to be considered. It exists in
abudantly in the most nutritious substances.
We have sufficient proof of its being nutritive
without a combination with Farina. It contains
says Hombolt more nutrition than any other
substance of equal weight & bulk. It is
said to destroy the teeth but this I am not
convinced of. Some people will have fine
teeth that use much Sugar other in a
similar case will have theirs decay.
It is disputed by some that it is improper
in scrophula but it is certainly injurious
In Gauty People it is hurtful. In Diabetes
it must be entirely abstained from, In cases
of worms it has been recommneded. [in]
[cases] but in ascarides & Teniae it must
be restrained from. In Scurvy it must be
employed with moderation it has occasionly
brought it on.
Oils are eminently nutritious; Cullen says
they are nutritious because they are
never found unchanged in our Blood.
It is not true, for in many cases it

4
is found in the Blood unmixed with it,
it is then usually considered as Chyle.
Nothing is more certain however than that
are very nutrition.
Gums & Mucilage we consider as having the
same Alimentary properties. They are eminently
nutritious. The Inhabitants of Senegal live
on water & Gm. Senegal during a scarcity and
with little inconvenience. Gm. Arabic is now
recommended in this city in the last Stages of
Consumption, Marasmus & Colliquitive Diarrhaea.
Water is oft itself very nutritious, first because
it constitutes so large a part of our System
secondly because it will support vegetables
for a long time on it alone and will
continue their natural secretions. Fish for
many months will flourish on it. Twenty
three month I supported a Rattle Snake on
it and at that period destroyed it &
it was fatter than the Snake is usually.
Lime is nutritious because it forms so large
a part of our body. The Flounder takes in
the whole of the oyster and dissolves the

9
it increases in weight by absorbing the Fanning
matter but when astringents are taken internally
or are applied externally this does not take place
Dr. Darwin supposes that they have a specific action
on the Absorbents, laud stimulate them into action
that they do not corrugate the muscular fibre.
I believe they do act upon the muscular fibre &
cause them to contract. I cut of the tops of several
pieces of Sponge, they bleed much, several I washed
with water they continued to bleed much, tho
other I washed with Acetate of Lead they soon
ceased to bleed. The Natures of Astringents I shall
not discuss, The Gastric Juice of the Stomach will
not dissolve Resins.
Astringents are very important in the case of
Intermittent & Remittent Fevers either alone or with
Bitters. In continued Fevers they are less to be
depended on. In many cases called Debility
they are improper; that Debility preceeding Dropsy
they are improper in; however in many Dropsies
there is an Intermittent or Remittent Fevers in
which they are indicated. In many Hemmorhages
they are useful. In the Profluvia they are

10
recommended, and are useful under certain
circumstances. In habitual Catarrhs they are very
efficacuous. Fluor Albus most Physicians use it in
& I have found them useful. In Glut & Gonnorhea
are very important when they are local. In the
Diabetes they have been much used but it is
such a constitutional Disease that it will not
readily yield to them. In Pyrosis they are useful
In some inflammations they may be employed.
Scurvy some astringents may be used. In
of nervous Diseases as Epilepsy, Asthma, Choria &c.
they [all??] are very necessary, In Cutaneous affection
they will augment the operation of Mercury. In
Calculi they are found useful, particularly
tho Uva Ursi. In Scrophula & Racheles they are
to be used. In Ulcerous affections and even in
Cancers themselves they often afford Relief.
The most important Astringents; [are] derived
from the Vegetable Kingdom. The Mineral
kingdom afford several; the Animal none.
Tonics
This is an important class. By
meant a certain set of

11
when applied to the system give strength
to the body. Raborentia I apply to this class
as the most unexceptionable term. Linnaeus
called it muscularia which is not very
improper. On certain occasions they may repress
a morbid action or give strength in other
cases to the solids. In the body exists a
principle called Incelibility, and also the
Vis Tonica which is that acted on by
this class of remedies. Doct Cullen supposed
the Tonic or Roborent power existed in the
Bitter property only. I suppose it also to
dwell in the Astringents which will hereafter
the class astringents to that of Tonics. This
property does not exist in all Bitters. The
warm & Cold Baths, Exercise &c. are Tonics.
This property does not exist in a vast variety
of substances of very different physical
properties. It is a necessary property that they
do not stimulate to excess but they do all
stimulate to a certain; they also increase
the heat of System notwithstanding Doct Cullen

12 
asserted to the contrary of this.
The Robocents may be employed in almost
all the Diseases mentioned under the
class of Astringents. The diseases of debility
more to be found in nations of luxury
require the use more especially of this class
of Medicine. They have been found useful
in Nephritis & Calculi; in Gaut they are
useful but generally at much expensive to the
system.
Stimulantia or Incitants
Are such as increase the faculty of sensation
in the sentient parts of the body and the
muscular action. Remarkable properties belong
to some of the stimulants called narcotic, that
of producing sleep is one. I shall not inquire at
this time how this differs from the natural sleep.
Some have considered Narcotics as direct sedatives
and we often use them for their narcotic
properties above, but well conducted exper
has fully evinced that they are directly
Stimulant in their operation. The heat is

13
vastly increased by Belladona. Opium does
not increase the temperature. Some narcotics
induce dryness of the fauces, thirst &c. Scirrae
of the secreations are increased by them.
No Diaphoretics are more certain than those
containing opium. Some of the Narcotics are
the most powerful Diuretics. The Liver is
increased in the action of Secretion by them.
Several produce a Cathartic power. Opium
in Colica Pectonium will purge. The Pulmonary
System is increased in strength; Opium is
often a good Expectorant. Their operation 
mind are very important & striking. Opium
often occasions itchings of the Skin. The
Cicuta will cause the Epedermis to be thrown
off. Persons killed by excessive doses of Narcotics
extensive inflammations were found on dissection.
They possess different degrees of this Stimulating
property. Belladona stands at the head of the
scale & Cicuta at end. It is a question whether
they are absorbed into the system or whether
they act alone on the solids. A Child was
thrown into a state of drowsiness from

14
sucking the milk of its mother who had
taken a large dose of Opium. Still I am
convinced that they act through the
intervention of the Solids in most cases but
that under certain cases they may be
absorbed into the circulation and operate
on the parts directly to which they are
applied. It seems from late experements that
poisens are absorbed and do not act
until this has taken place. The
Animal Kingdom affords several important
Stimulants as Musk. Cantharadin. &c. The
Vegetable has many, Wine, Alcohol, Ether
Beer, Narcotics, Camphor, The Pines, Balsams,
Resins, Mustards Horsradish, Garlic, Onion, Foetid
Gums, Animal secreations as the poisens of Bee,
Rattle Snake. The modus Operendi of these animal
poisons is not [fuull] known, but I believe
them to be absorbed into the System. The
warm bath is a powerful stimulant at about
98°. An excess of it is injurious.

15
Electricity is a potent Stimulant, its effects is
extend to vegetables as well as to animals
Perhaps it may be an useful remedy in
Spasmodic affections, yet it must be remembered
that it has induced Tetanus. T
Phosphorus has of late been used but I have
never employed it. Oxygen Gass is considered
a powerful Stimulant, it often stimulates more
than heat. Certain passions, anger, joy, love, &c.
are stimulants, but these passions are little under
the controul of remedies. Stimulants are indicated
in every disease that is founded in a morbid
weakness in any part of the system, they must
be proportioned to the extent of the disease.
Stimulantia Evacus.
This class should be divided into orders-
Bloodletting is an exception to the evacuents
in not being a Stimulent.
Errhines
Are medicines which procure a discharge
from the nose, the evacuation is often
attended with sneezing. They generally go

16
further than merely to give the health
action. They relieve a Rheumatic congestion
of adjoing muscles. They are used in Deafness
of some kinds with much advantage, One
species which depends on the Eustachian Tube
from colds, owing to a swelling of the skin
have adjoing the tube, a noise is heard
in the head, a peculiar sensiblty of the organ
of hearing; it is often curable. Epispastics, Cuppings,
Blisterings, warm dress, Issues & the Errhines
are to be employed. Gutta Serena when a
local affection they are useful. Said to be found
useful in the Cataract, as white vitriol &c,,.
In several cases in London they have disappeared
on Opthalmy. ensuing. In Hemecranii they are
advantagious, should be such a produce
much discharge. In Polypus they are serviceable.
In Hydrocephalus they must be used with
caution. In Epilepsy where there is little
determination to the head. Probably in
Tetanus with advantage. Opthalma particularly
in Chronic kind I have found them useful.
In Bronchoae the mercurial ones I think

17
would be useful. This class has been much
neglected and I think deserve much more
attention. In Epilepsy, vertigo, &c. I think they
ought oftener to be used. Spontaneous Sneezing
I find to be a favourable symptoms in
many diseases, in yellow Fever, Hydrocephalus.
They are mineral & vegetables. From the form
Antimony & Mercury in different preparations.
would be useful. Turpeths Mineral is most-
used, I have known it to induce a salivatia
where other remedies failed to do it.
Sulpht of Zinc in solution is one.
Euphorbium is a powerful one, White
Hellebore is powerful and safe. Tobacco is
well known. The sudden discontinuance of
Snuff after long using it is often dangerous.
All the symptoms of Dyspepsia have been caused
by the use of snuff. Maniacs are fond of
Snuff though they dislike it in health; it is
probably it serves only to increase their
disease. The use of Tobacco does not seem
to lessen longivity, Diqatilis is one of the
Errhines. The Asacabecca is one. The [D?ke]

18
Sialagogues.
Such as produce a flow of the Saliva; they
also stimulate more or less the whole system.
Many acrid will excite this discharge when
applied to the Tongue. Anthemis Pyrethreum.
Tobacco, Imperatoria, Camphor, Horse Radish
useful, Xanthoxylon, Seneca, are among this
class of remedies. I suppose that every Stimulant
is also an evacuent.
One article only has been discovered to be an
internal Sialogogue, this is Mercury, Is it
ever absorbed into the circulation? For 12
hundred years it was not doubted by any
one. Of late it has began to be doubtd
whether it is ever introduced into the
system by absorption and they suppose that
it acts wholly by making its impressions
on the Solids. Many facts have been held
up to shew that it is actually detected in
in the circulation, in the Bones & muscles.
Of late few only have pretended to detect
it in the solids of the body; Dr Bostwick

19
of England has pretended to exhibit in a
person who died of the Venereal disease
who had long taken it. Dr. Barton has Known
of a case in the Anatomical Theatre of a woman
who had been using it in whom it was
found in the mineral State. It has been found
in a tumour on the cheek of a nobleman
who had taking it internally... It is. said
to have been found in the milk of a woman
who was under a mercurial course. Children
have been salivated by their mothers who
were using it. This might have been done
by their mothers Breath. I do not feel my
permitted to deny that when it has been long
used internally that is absorbed into the system
but I think it necessary that it should be
continued a long time. Dr [Wormsley] has found
that the Lymphatics will take up substances
after being unduley stimulated that at
first would reject them. This is found to
be the case with vegetables by experiments
of Doct Barton. Are we sure that our

20 
that our chemical tests are seen to
detect mercury under different situations?
May they not be unable to do it when
invested in a large proportion of animal
fluids? We find them inadequate to do
it when mixed with mucilage & Gm,,
Arabic. How does mercury cure the venereal
Disease? When first issued it was with the
intention of procuring evacuations, and they
supposed it cured by driving out poisenous
particles, from the body. That this is incorrect
is certain that the venereal may be cured
with mercury with little or no evacuation,
& that other powerful evacuents will not
cure it. Dr Cullen supposed it was owing
to the evacuation by the Salivary gland
but this opinion is now neglected. The
mechanical sect supposed it operated
mechanically in curing the venereal.
The chemists supposed that it acted by
being an antidote to a poisen, by neutralizing
it. This is a favourable doctrine &

21
will be in all probablyty will be long held
up. When venereal matter is mixed with it
once innoculated no chancre was produced,
but the Small Pox matter would take when
mixed with it. Experements go a great ways
to make it certain that it does act
chemically in curing the venereal disease.
It is to be considered certain that it is
absorbed into the blood vessel to cure the
disease by chemical action. It seems to be
necessary that considerable irritation must
be induced before this will take place, It
would also seem necessary to confirm this
doctrine that large quantities only would
be necessary to [crossed out] be taken into the
system. to cure this disease. Some suppose
that it acts according to the different quant
of oxygen the different preparations contain,
yet this does not appear to be correct.
Oxygen will not salivate of itself & we
find that the preparations do not salivate
according to the quantities of oxygen

22
they contain. Mercury is not the only
remedy that Salivates, Cicuta, Camphor,
Polygala Senega &c,, will often do it. In
Scorbutes there are many symptoms which
resemble those of a Salivation & we find
them cured according to the quantites
of Oxygen given the vegetable food. According
to Mr Hunter Mercury acts by changing the
action of the living parts and corrects the
poisen of the venereal virus; that the irritation
of the mercury is superior to that of
the venereal one. But as an objection it is
impossible to cure it with other powerful
stimulants. I have not yet become satisfied
with any one of their Theories
It seldom operates as a Silagogue on children
under two years, though it may occasionally
happen. I have seen no person so old that
he could not be salivated. Some persons
are entirely insusceptible to mercurial
irritation. One case where every other form
had failed Turpiths mineral as an Errhine
caused it. Do not they Operate more

23
easily in some seasons than in others?
The exhibition of mercury internally is the
neatest method of giving it, but in
some habits will require other methods of
administration. Calomel has been rubbed into the
gums but is not a good method.
Employed as an Errhine I find useful.
As an unguent it often operated well applied
with friction. Mercury acts more readily
when applied to the inside of the Thighs
wrists, & arm-pits. Friction is necessary,
Camphor II℥ to II℥ of ungt,, answers a good
purpose. Worn in socks or shoes it will
induce salivation but I have had but
little experience in this method. We have
often applied it in Blisters but I am convinced
that it is efficacious. Salivation is soon
produced by fumigation of Mercury. The
Cinnibar is placed on coals & append
under the thighs & confined under the
bed clothes. This often affects the Bowels
and when this happens it should be

24
left off. Some system are so highly excited
that evacuations are required to proceed it.
Nitre has been recommended to hasten its
operation. Digitalis to depress the pulse is
useful. When the system is too low must
be excited by different Stimulants. Warm Bath,
is one remedy. Smoking so as to nauseate
might perhaps be useful with it, Is not
indicated in Fevers of morbid actions
till other remedies have been used, Dysentery
of [illegible] In Scurcy is hurtful,
Salivation is somewhat metegated by gargles
of astringents, Cold will arrest it for a time
but I doubt of it safety This was Doct
Rushes method of arresting it.
Opium itself in large doses or in Dovers
Powder is very efficacious and certain.
Sugar of Lead may be used as gargles
or internally where Opium cannot be used
Salivation is often necessary, but so much
use without discrimination has done much
hurt.

25
Salivation is usual in pregnant women, in some
even from
Expectorantia
Romote secreation & discharge from the Lungs &
Bronchia. There are no medicines that act specifically
on the Lungs alone yet, this term may be used
as well as Diuretics & Errhines. The alliacious, &
Siliquous plants are expectorant. Poly. Seneca is a
sure and powerful; strong Coffee is not to be
neglected, I have found it useful in my own
cases, fumes of narcotics, preparations of mercury
particularly corrosive Sublimate & Turpeth Mineral
Gums, Mucilage, are Expectorants. Opium is also one
acts to quite the irritation & also to stimulate
the Bronchial system. Blisters have an expect
effect. Blood letting assists it in several diseases.
Pneumonia, Cynarcha, Tussis, Asthma, Hdrothorax
may be used in. Improper in cases of morbia
& increased action in the lungs, Catarrhs
resembles the Fluor Albis might not Expectorants
be useful when the Fluor Albis was excessive

26 
Emetics.
Such as excite vomiting & evacuate the Stomach.
Cathartics venesection, & Emetics are used by all
nations, even the most uncivilized Savages.
The Six nations employ 15 or 16 different ones &
most of them from the vegetable Kingdom.
Vomiting is natural to Man and many animals
the Owl & Eagle throw up the feathers of Birds
that they have eaten. The Horse cannot vomit,
owing to the power of the Sphincter of the upper
orifice of the Stomach, it falls into action with
the Stomach when an Emetic is given. I do not
beleve they are too often used but I believe
they have been used injudicously in many
cases. An inoperation makes the Diaphragm a
plane, the Abdominal muscles then act & a
pressure is made above & below; an inverted
action commences at the Pylous and a vomiting
then ensues. Some have supposed the Stomach
to be only passive but this is incorrect. Some
French writers have asserted that the Stomach
will be emptied without the action of the

27
Abdominal Muscles. But experiments on a Dog has
dicided this to be incorrect. Vomiting is a very
complicated action, almost ever muscle in the
body is affected in a violent case.
This first effect is to evacuate the stomach & usually
the Duodenum, very frequently Bile is thrown up
which must come from the Duodenum, except in
some morbid affections of the Stomach Bile may be there.
However of late it is supposed by some that a small
quantity always there to assist Digestion.
Vomiting excites the whole system of Circulation,
but this increased action soon is diminished
& even below the Natural. They often proove
Diaphoritic but all emetics do not excite this.
Vomits often reduce swellings of the Testicle but they
are not so employed as other remedies will answer
better. I shall divide them into the vegetable &
mineral Emetics. Much has been said respecting the
choice of Emetics in different diseases and I think
not improperly. Antimonials we use in Fevers,
probably because of their determining to the Skin.
Ipecac is preferable to any other in Intermittent
and Dysentary of some kinds.

28
Ipecac, White Vitriol & Infusion of Mustard for
the evacuation of poisens, particularly the
former is supposed to neutralize some poisens
as the narcotics. Sulpht of Copper is now
very popular in Europe. Tobacco I use in a
peculiar manner for poisens. I give Blue or
White vitriol internally and apply Tobacco on
the Stomach externally, this application will
almost invariably evacuate the Stomach where
other powerful remedies have failed.
Emetics are improper when ulceration of the
Stomach & Intestines, Inflammation of them,
Vomica of the Lungs, Fevers with a determination
to the Head. Many cases of Pregnancy, i.e
The Vegetable Emetics are usually milder than
the mineral. Ipecac, about 10 Gr is a midium
dose. The idea that a large & small dose of
it act equally alike is incorrect. Climates &
state of the System vary their operation.
Cathartics
Are such as open the Intestines downwards.
Must have been employed among the most

29
ancient remedies. They are natural remedies
are used even among the Brute creation.
They act on the Stomach & Intestines, increasing
the peristaltic motion, stimulate the adjacent
viscera, as Liver, Pancreas &c, also Kidnies &
probably the Spleen. What precise effect they
have on the absorbent system we have not
yet learned. The heat of the system is increased
at first by active cathartics, but afterwards
diminished. Their principle action is on the
Intestines but some cathartics are taken into
the system and have ulterior effects. Some
suppose there is a more direct communicate
between the Intestines & Bladder than the
circulation but late experiments have shown
that the rout is through the circulation. A
suckling child is sometimes purged by the
mothers taking a Cathartic. To me in my
practice it has occured at least in 50
cases. Rhubarb largely taken will colour the
milk of the mother. Do they when applied
to the surface have any effect? _

30
Is said that a person under operation of a 
cathartic are more easily operated on by
Cold, Blisters often assist their action, when
applied to distant parts as in Issues. They
differ much in their effects, they have a
specific action, producing their effects on
[peculiar] particular parts. Although the chief
indication is to evacuate the Intestines yet
they have a more general action on the system.
In Fevers of all kinds are in most cases very
necessary, not excepting the Typhus. In local
inflammations, in obstructions in the Abdomen
afflictions of the Head, scrophula, obstructions
of the Catamenia & worms they are to be used.
Cullen has divided them into Mitioria and
Acrocia but I shall not confine myself to
his division. I first arrange them then into
vegetable and Mineral ones.
In Colica Pictorum & severe constipations without
inflammation cold applied to the feet will
often produce an immediate evacuation.
They are few disease in which Cath

32
may not be given but much depends on
the Choice of them.
Diaphoretica, or Sudorifics
Are those remedies which produced increased
perspiration. Authors have divided them into
Diaphoretics or those which produce the
insensible perspiration & Sudorifics those which
produce the sensible or sweat, but the same
remedy by varying the dose may cause
either. Are highly valuable in Diarrhoea
and Dysenteria, in Rheumatism, Gout,
Dropsies, Hemmorhage particularly the uterine,
in Diabetes, in Calculus, & perhaps in some
cutaneous Diseases. They should be administered
in the morning says an author, but I have
not followed his directions, I have often given it
at night. Emetics are mostly Diaphoretics, two
only are excepted Fox Glove and Squills, but the
former I find to induce sweating. Dovers
Powder composed of Ipecac, Opium, & Alium
is very useful. Asclipias Decumbens has this
property. Seneka, Eppatouium [illegible] is

32
a powerful one. Rush called it the vegetable
Antimony. The alliacae are also. Mercurial
Preparations of Mercury, of Antimony &c,,
Cantharadics have this effect, vol Alkali
particularly in wine whey. warm & Hot Bath
Cold Bath under certain circumstances,
have this effect. Animal Food more than
vegetable is sudorific, & thus the former is
to be used in Diabetes to change the
determination to the Skin. Leprosy is more
often found among the eaters of vegetable
than animal food. Exercise is a valuable
Diaphoritic. Proper clothing requires to be used
it has much influence on this discharge
Flannel is preferable to Linen. & is much
more healthy, the former remain dry &
warm on the body, it is a bad conducter
of Heat. It should be used in every part of
the United States. It dois not tend to
debilitate. It would prevent many

33
Diuretics
Are such as increase the secretion of the Kidnies
There is no medicine that will always act as
Diuretic. None are merely endowed with this
property alone. Their mode of operation is
altogether uncertain. Doct Cullen supposed
that they must be absorbed into the system
and applied immediately to the Kidnies
unchanged; that this is the case with some
remedies I cannot deny as for instance Spt of
Terebinth; I could never beleive that this is
the case with Cantharadics; Hence I belive that
this Diuretic power acts independantly of
their absorption into the System but must
act by Sympathy. That Digitalis as a stimulant
was first taught in the university & is now
taught over all Europe. The Squill is more
certainly stimulant. It is necessary to administer
into the system with a sufficient quantity of
mild fluid to satisfy the thirst of the
patient. The reverse of this doctrine was
formerly taught. Diuretics were not much
known or used until of late years.

34
Used in Dropsy & form an essential fact
of remedies in many cases. In increased
arterial action, with Plethora other mediums
will perform a cure without them. Also in
cases succeeding Typhus vol Alkali, Opium,
wine &c will be the proper remedies to be
employed. In this kind these narcotic ones
would be injurious. Cases of this kind are
not unfrequent. Dropsy is often combined
with Intermittents and require medicine on
particular days. In Hydrocephalus much
has been said of the use of Diuretics: In
Epilepsy have been recommnd. In Apoplexy
& Mania are sometimes important particular
in Mania with affusions into the ventricles
of the brain. In Scarlet Fever Digitalis
has been recommended in the last stages.
Sometimes in Acute Rheumatism particularly
where there are Dropsical swellings. I now
use Digitalis in this disease with success.
In Hepatitis I find them sometimes useful,
In Some cases with scurvy but much

35.
[co??] is necessary, Stimulating ones only [illegible]
to be used. In Glut & Gonnorhea they are
often of advantage particularly in Chronic.
Glut. In the cases the Stimulating Balsams are
to be employed, also the Siliquam. In
Calculi of the Urinary Organs, the Narcotic ones
are useful. In Diabetes are contraindicated
Diuretics have several times laid the Sound
action for this disease. In Retention & Obstruction
of the Mensis some are useful. In Cutanious
affections have sometimes been useful. -
Antilithics
Are such as operate upon the urinary calculi.
This is used instead of the term Lithontriplices,
They are such as relieve the symptoms of
Calculi. I cannot deny but that some remedies
may dissolve a stone. A case in St Thomas,
Hospital while the Stone had been often felt
was treated with these remedies, the patient died
of another disease long after the calculaus
symptoms had subsided, the stone was
found very soft & appeard to be dissolving

36.
Most of this class I consider as preventing
the formation of the Stone. A disposition to
the stone is natural, is as common among
Savages as among civilized people, the Savages
have given us some important remedies
in this disease. All animals are more or
less subject to it. not only in the urinary organs
but also in those of Digestion. It seems to be
less frequent in some countries than in others.
Is it dependant on any peculiarity of soil in a
country? It has been supposed by some to be,
but I am not inclined to think that it is
not more frequent in Calcurious countries than
in others. Glutt is liable to lay the foundation
of Calculi. In many cases of Calculi in children
in Paris were children of very Gouty Parents.
We have instances of [illegible] pains [alu???ty]
with swets of the feet. There is no doubt
but that there are caculous Diathesis. A
morbid affection of the Stomach often seems to
lay the foundation of Calculi. This affection
of the Stomach is Dyspepsia of a peculiar

37
kind attended with the prisence of a
vegetable acid in the Stomach. Yet thousand
Dyspeptics have no affection of Calculi.
A predispositon probably exists, yet some
persons predisposed may escape it. A Stone
usually finds some substance to form on,
and is called a neucleous. When an
extraneous Substance finds its way into a
Bladder a stone will form. Probably there is
always a nucleous exists in every Stone,
the [asca?adi?s] may often be one. Stones
sometimes form in Foetuses. In the decline
of life most often the effects are perceived.
The stone consists of uric Acid, uriate of
Ammoni, Phosphate of Lime, Phosphate of
Magnesia, Oxalite of Lime & sometimes some
Flint. One of the largest weighed 3lb 4oz. &
nearly filled the Bladder, The remedies are
Astringents (tho vegetable ones, Tea, Hazel nut,
vaccinum, Pysola, uva urse,) Bitters, (Quassia
Chammola) their mode of operation is not
well known various theories have been adopted,

38
Cullen supposed they absorbed acid in the
Stomach. They produce no sensible effect but
that of relieving pain. I think they act as
a specific, the astringents cannot act by their
Roborant power alone, We sometimes meet with
a case of Nephritic Calculus, in which the
Uva Ursi increased the discharge from the
Bladder, I do believe that they do expell the
Calculi. Certain narcotics are useful, the
Digitalis & Tobacco, I know by experience that
they do often relieve the symptoms. The aleaceous
plants are useful, the Leek & Garlic are certainly
proper to be resorted to, what their effect is
we know not. The Alkalies have been much
used; two, the Carb. of Soda & Magnesia I
have found advantageous. Moderate doses
must be given 18 or 20 Gr of Magnesia, twice
in 24 hours. Certain acids are useful, the
Carbonic & Muriatic are certainly useful
occasionally. The latter in 12 or 15 Gt 3 times
in 24 hours have lately come into use. I have
seen one case cured with this acid.

39
Emenagogue
Those remedies which correct the morbid condition
of the Uterus are two, Emenagogue,
The menses are retained or suppressed. The
sympathy which exists between the uterus &
other parts is so powerful as to affect the
whole system where it is diseased. Tonic's
of Vegetable Kingdom, may be used, the Rubia
Tinctoria, Stimulating bitters, Tinct of Melampodium,
Musk, Castor, Iron in different preparations.
I have combined Iron & Ol. Sabina with success,
as auxillary animal food should be used,
The Cold Bath is salutary in obstruction &
retention is particularly suited to cases of
debility without cough, or local inflammation
or [deli???ation] to the head. Exercise of
various kinds, Frictions are useful. Emetics
are sometimes very useful; a flow has been
suddenly produced by an emetic; Cathartics
are useful, have a two fold action, one
like Bloodletting, the other an immediate
impression on the Uterus. I also belive that

40
some have a specific action. Stimulating
Enemas are also useful, as Aloes & milk.
Diuretics have been recommended, as Digitalis
Cantharidics & Squills, What effect would the
Errhines have in this disease? _ Stimulating
pessaries have been employed in Europe. A
change in a situation in life is highly
proper and useful, Marriage often produces
the cure but this does not always [cure]. effect it.
The atmosphere has much influence on this
discharge. An elevated situation will often 
produce it. The remedies should be given a
few days before the proper time for the
evacuation to appear. Otherwise many would
be hurtful, others inut. The general Roborant
remedies many be used at any time.
Anthilmintics
The Fluids contain organized animal bugs which
are necessary to the system, besides these here and
frequently many extraneous animals are found
in different parts of the body. Butterflies are only

41
often found in the Fauces of the Deer,. Worms
are frequently found in the Intestines whether they
are extraneous or whether born with us is a
point of controversy. I think the last is correct.
There are three kinds, one of about three inches
in length, has been supposed to be of the same
species as the Earthworm but they are totally
different. The Earth worm has rings, the Lumbricus
has not. This worm has never been found out
of the Intestines, they exist in infants who have
only feed on the milk of the mother, even it
is said in the Foetus, It exists only in Human
Beings. It has been found in the cavity of
the abdomen, Pancreatic & Gall ducts, Thorax
Trachea and Perecardium. The second is
the ascaradies is similar to the other but much
smaller, so circumstances seen to evince that
they exist naturally in the Human System. They
travel from one part of the body to another
They are infectious, I find them so by experience.
The Tenia or Tapeworm, several may exists in
the same person at the same time. There are
two species in the Human System. They have

42
many joints, each joint contains its own viscus.
The seperate joints will possess its life for a
long time. Unless the head portion is brought
away the joints will soon regenerate. They
usually occupy the small intestines, but they
sometimes get into the stomach and may be
vomited up. Doct. Rush supposed they occured
most frequently in Foreigners. They have been found
in the Foetus in utero. I am inclined to belive that
all their species are natural to us. They die
very soon after they are expelled from the Intestines,
Many of our diseases I consider symptomatic of
worms. Itching of the nose, pale urine, itching
about the anus, pulse irregular pulse, appetite
& Bowels, Tumid abdomen, Mucous stools, strating
& Grinding of the teeth, weakness, often cough,
fever, &c,, are often symptoms of them. I am
persuaded that in some weak habits worms will
cause a new Fever, These are scarcely, a symptom
of nerves discard but that may be induced by
worms. Epilepsy is sometimes caused by them,
also Chorea, Tetanus, Hypochondriasis (Hydrocephalus
is often confounded with worm symptoms)

43
The constant irritation of them may lay the
foundation for incureable diseases in the Brain
The Tubes mesentareia, is often caused by them,
The only certain diagnostic is the evacuation of
them. Dr Darwin has known them cause Polypi
in the nose. I have known Opthalmia caused
by them. The Cynanche Trachealis I have seen
caused by them. Paralysis is sometimes induced
by them. sometimes jaundice. They may exist
without doing any injury, and even some have
supposed that they serve some useful purpose,
this I do not consider as correct, only in one
view I can consider them as useful, that of
preventing other disease by their irritation of
the Intestines & Anus.

44
Practice of Physic
The cure of diseases depends much on their proximate
cause says Doct Cullen but to this I do not subscribe.
Nosology is the arrangment of diseases into Genera
& Species, it is also a general view of the several
diseases. Is of importance in the study of diseases.
Many diseases are closely allied but still are
seperate in some important symptoms as Gout and
Rheumatism. Cullen divided them into Four Classes.
each of which is subdivided, then again divided.
I shall not confine myself altogether to his system.
Fevers _
Here I mean those without any local affection
that is primary. I shall avoid giving a
particular defination of Fever, it appears under
so many forms and symptoms. It is the disease
of all climates and seasons. More than one half
of mankind die of it. It is considered by many
nosologists as being much more extensive than
we have considered it. Doct Cullen considered
many of the discharges of morbid kind as Fevers.

45
I think Fevers ought to be considered under
one Genera. All the Genera of Fevers of authors
ought to be considered as one. We daily see one
kind run into the other. I would abolish all
the Genera of Fevers of Cullen & Duncan and
only consider them as species or varieties. I
consider them as all of one Genera, simple Fever
seems to be the Generis. After the action of the
remote causes (whatever they may be) coldness
is observed either general or local, often greatest
in the extremities, or along the spine. The sense of
cold is very much diversified. Often the cold
is but small when the succeeding symptoms are
very severe. We find by experemants says Duncan
that the temperature of the body is not reduced
by experements now have shown this to be
incorrect but the deminution is not in proportion
to the sensation of the patient. The sensation 
seems to be different in different species. The Cold
stage often comes on with stupor or coma, though
it is not a certain symptom, sometimes a Head
ache comes on with the cold but usually

not until the Hot Stage, A cough sometimes
ushers in the cold stage. The pulse is increased
in quickness, Is seldom under 90 in a minute
or over 160 in Fevers. In a adult person in health at
rest be betwixt 70 and 80. Is quick when above
100.. frequency, velocity & celerity I consider the same.
along with the velocity of the pulse an other
symptoms which indicate still further a morbid
state of the Heart & Arteries,. Sometimes in Fever
it may be slower than natural. A heat above
the natural temperature is another symptom of
Fever. Some-times has arisen to 112°,, usually 104°,,
is very great. In Remittent & Intermittent the
excitement is irregular, and Doct Rush questioned
whether the system contains more than natural.
Febrile thirst is a common occurrence and
often to an intense degree: it is not however
an essential symptom of Fever. Much has
been said of Febrile debility; in this there is
something peculiar in it. There is sometimes a
morbid increase of strength, This debility
has the appearance of that of an intoxicated

person. This may be considered as an essential
symptom of Fever, A patient raised into a
perpendicular situation immediately fails but
as soon as he takes a horizontal posture he
gains it. All kinds of fever are preceeded by
general debility. A peculiar general anxiety
of the patients is to be observed in Fevers-
Delerium often attends Fevers, but even when
it does not take place the mental faculty
is irregular. Sleep is unnatural, and does
not afford relief to the patient. The Resperation
is disturbed in cold & hot stages, and is
relived by the sweating stage. A Fever of only
one paroxysm rarely occurs but I have seen
it. This is the Ephemera is more common in
Europe. Fevers are divided into Continued,
Remittent Intermittent
When a Fever consits of several paroxysms the
intervals are usually equal. When it 48 - it
called the Tertian and is the most frequent,
a Remittent is where one paroxysms is nearly
completed before another commences.
A Continued fever is where the [??roxy]

48
continues without any cessation. Most commonly
a crisis is marked by some evacuation,
but evacuation is not always a symptom
of a termination of the disease favourably,
The most frequent one is Perspiration, also
in urine in increase of quantity & colour,
changes, deposits & cupeous sediment, Sometimes
a Diarhaea makes a Crisis and is
a favourable one. Sometimes a violent Hemmorhage
as Epistaxis. It is principal in the first stages
that natural bleedings are to be considered
favourable, in the last they are bad
symptoms. Natural Salivation is a good
symptom & sometimes is a critical evacuation
A change in the secretion of the mouth is of
much importance and usually marks a
crisis. and will often be a mark to give
remedies by. Bark may be given when the
tongue becomes moist, Sometimes by [illegible]
as does acute Mania. An increase of all
the symptoms have [often] sometimes immediately preceeded
the crisis. Critical days have receved much
attention, is there any foundation for the Idea

49
of Critical days? I am far from [illegible] convinced that
this idea is correct. I have seen no circumstance
that would confirm it. These days are those
on which the disease will proove either
favourable or unfavourable. I believe that this
idea is altogether a production of fancy.
Dr Rush was a believer in critical days, &
also Doct Cullen. It is difficult often to tell on
what day the Fever commences or terminate,
hence it is hardly possible to tell what day
to count from. In many cases where the begenning
and termination were distinctly known, we
find the disease ending on days that were
not critical. Hippocrates first described these
days, Asclepiades rediculed them, Doct
McBride of Edinburgh and Dr Rush advocated
this doctrine. They supposed the ancients were
able to see these days because they left these
Fevers more to the course of Nature than the
Moderns - and hence they were uninterrupted,
and also that the climate of Greece & Rome
have peculiar effects on Fevers. But we
are unable to find these days in similar

50
climates at this day. The Ancients were no
more mild in their practice than those in
the South of Europe at this day. No One
since the time of Hippocrates has been able to
add any new argument in favour of this
doctrine. It is founded on the ideas of
numbers - that the 7th,, number has a connection
with the Human System.
I shall no proceed to individual Fevers -
Intermittent Fevers.
Is a Fever consisting of a succession of paroxysm
with [crossed out] apeyxia between them. Perhaps there is
not always a complete absence of Fever,
between the paroxysm. Is a disease of all
climates. Linnaeus says the Laplanders know
nothing of it. It is regular or irregular, In
former paroxysms return at stated periods, the
last at uncertain. They are divided, into
Quotidia, Tertians, Quartian, &c,, but they are
not distinct Genera, only natures. Quoti
come every 24 hours, Tertians 48, Quartia 72.
besides other varietis are mentioned but they
are very rare. as Sextian, Septian, Octian &c,,

51
They occasionally occur, The Octian I have
once seen in a case of Jaundice, it occured
on every Saturday morning. And others are
said to have still longer intervals.
When the paroxysms occurs daily but is
lighter every other is called a double
Quotidian. Besides these varieties of forms the
Intermittents have receeved different names
according to the season at which they occur
as vernal & Autumnal. In the first the
phlegmasi type or phlogistic is apt to occur
and the Typhus in the Autumnal. The Quartian
has the longest & most violent Cold Stage
Every variety has three stages Cold, Hot & Sweating.
The Cold commences with shivery, tremor. The
Cutnaeous vessels shrink, chattering of the teeth,
anxietty, dryness of the mouth, small quantities
& clear Urine. The duration is very uncertain,
from 12 minutes to 80 hours. I have never
known a patient die in this stage, the Hot
The hot stage comes on gradually, but soon becomes
intense, it is not more severe in this Fever than in the

52
Remittent, is attended with Heat, Flushings of the face and
other parts, Delerium, Coma, Thirst, Respiration quick but
few, pulse less weak than in the cold stage but is
quicker, Urine high coloured. The violence of the Hot
Stage is not always proportionate to the Cold. Its
duration is uncertain. Is usually flawed by sweating
and discharge of Urine with a copious sediment.
The duration of Intermittents is uncertain, often is
arrested by a change of weather. The Quartian have
lasted several years. The viscera usually become
obstructed by a long continued one. They sometimes
releeve nervous affections, often induce them or
alternate with them.
Prognosis. Is the art of determinating what the
termination of the disease will be by the present
symptoms. Among the favourable circumstances in
Intermittents are an Eruption about the mouth,
a Spontaneous Salivation, Abscesses in the Groins, armpitts
Parotid & Maxillar Glands, Cutaneous Eruptions with
itching, This disease is more dangerous in Hot
than in Cold Climates. It is unfavourable to be
these appear when other more dangerous Fevers

52
as Plague or Yellow Fever are prevailing. Early
appearance of abscesses is unfavourable, dryness
of the skin and Petechia.
Predisposing Causes. Previous Intermittents, Debility
Occasional Causes. Effluvia from stagnant water,
Miasma, vapour of water, we have have no
reason to conclude that this disease is even
contageous. Exhalations of certain living vegetables
as Datura Stramonium. The most universal is
the Marsh Miasma, it is probably different from
any of the Gasseous Bodies that we are acquainted
with. No chemist has yet detected it, Dr Mitchell
supposes it to be a peculiar acid which he
calls the Sceptic, This Idea is too ridiculous
to claim our notice. That kind of miasma
exhaled from Peat swamps is said not be an
occasional cause of this disease. Blighted Grain
has been considered as a cause. Dr Rush
supposed the pollen of Flowers was also a cause
but I have never met with any circumstance
that would confirm this Idea.
I believe that different Fevers are produced from the same

54
kind of miasma differing only in the degrees of
concentration in which it is applied to system. The
period of time from which it is applied to the that
at which its effects appear is uncertain. Sometimes
a paroxysm occurs the same day on which miasma
is applied others not within 21 days. It is different in
different habits and under different circumstances. In
the Yellow Fever of this city the usual period was
7 or 8 days. The power of Miasma may be suspended
by more potent agents, as for instance the matter of
Small Pox.
Doct Currie supposes that it is receved by the
Lungs and never by the skin; I am daily becoming
convinced that it is not absorbed by the Skin.
Doct Rush supposed that this matter might affect
persons 9 miles from the place where it was firs
generated, I belive it may at a still quarter
distance.
Cure. In most instances this disease is under
the contraul of medicines. We see that it is not
always necessary to know the proximate cause of a
disease to perform a cure.

55
Indications. 1st,, To prevent the return of paroxysm
during the intermission. 2d,, To conduct the patient
through a paroxysm. 3d,, To remove the causes.
1st,, What the operation of Bark and other remedies
is fufilling this intention is uncertain. I doubt whether
they act merely by their Tonic properties. I am far
from thinking that the return of the paroxysms from
depends merely on weakness, however I have no better
Theory to explain their operation. The remedies are
principally the Roborentia. Cinchona stands at the
head of this list. There are 3 kinds, pale, Red, &
Yellow. They all have one assemblage of properties.
In the 17th,, Century it was first brough in general use.
It was formerly given just before the commencement of
the Cold Stage. This was the practice of Sydenham &
Cullen. I do not admire this practice; practitioners of
experience have rejected it at the present time.
Just before the Cold Stage the Stomach is peculiarly
irritable and apt to throw off what is taken
into it. The Operation of Bark is also slow, some hours
pass before it has much effect. There are fevers in
which we must press it on the patient to the last
moment before occasion of the Cold Stage, and in

56.
[Indications] in large doses, as in some
Quartians and other species of Intermittents when
some malignant Fever prevails in the vicinity.
We should cease when the Cold Chills commence.
It has been my practice to begin with large doses
of Bark as soon as the sweating, & Head and Back
ache go off and continue them till the next paroxysm
commences, gradually diminishing them in quantity.
This kind of practice is peculiarly adapted to the
Quotidian Type.
Is Bark admissable in the Hot Stage? It has been
considered in almost every part of Europe as improper
in this stage, but some East India practitioners of
late have recommended it in every stage of Fever,
but I think that practice would not answer
in the Cold Climates if it will there.
The medium dose is from ЭII to Ʒi. It is often rendered
more useful. When the Intermittent partake of the
inflammatory diathesis neutral Salts should combined
with it, when of a Typhoid Type Cascarilla, Red Pepper
Mustard, Ol Cajeput &c,,. Opium is chiefly used with
it to prevent its running off with Stool. The best continuation
in the Typhoid kind is Aristolochia Virginiana.

57
The Super Tart of Potash is used in Some Southern Climates
in combination with Bark. To Bark ℥i add ЭI of
Crystals of Tartar. Arsenic is also combined with
the Bark. In some cases of Fever I have used
small doses of Rhie, In certain Fevers of only
two paroxysms of the Tertian Type it is said the
cure depends of the large doses of Bark with [cathar???]
Bark is usually given into the Stomach, sometimes
as an Enema & externally. It has considerable
effect when applied in a quilt, round the
chest; the quilted jacket must be taken off
during the paroxysms, or they will be aggravated
by it. Besides Bark there are several important [to]
Tonics, Willow, Cornus, Magnolia, Calamus
Aramatocus in doses of Ʒss every hour is useful,
Kino Gum I have used it. The Terra Japonica has
much effect in Intermittents, in some cases
superior to Bark. Sulphat of Zinc, preparations
of Iron, Arsenic.
Preparations of Zinc I have used but little in
this complaint. The Oxyd of Zinc has cured some
obstinate cases.
Preparations of Copper. Sulphate of Copper has

58
used by some practitioners and I have used
it with success in cases that have resisted the
Bark, It must be combined with aromatics.
I use 1/4 of Gr,, for a dose, the cure proceeds as the
sickness comes on.
Preparations of Iron have usually failed
in the United States. But the Carb. of Iron will
occasionally assist the operation of Bark. The
Acetate of Lead have sometimes been used
and with some success but is a powerful
remedy. The most useful of the minerals is
the Arsenic, sometimes is superior to Bark. There
is no managing some cases of Intermittents particularly
of children. Two preparations of it are used,
The Fowlers Solution & the White Oxide, The
best method of using it - if my patient is an
adult and nothing peculiar in the constitution
I give 5 Gtt 3 times in 24 hours. This is large
enough to begin with, I usualy use it in pills.
so as to give 8/12 of a Gr in 24 hours. Its good
effects usually are soon observed if it is to
have any, if not in 3 or 4 days I lay it aside

59
[illegible] It is peculiarly suited to those Intermittents in
which there is considerable arterial action
in which depletion is indicated and it is
injurious in those kinds tending to a Typhus
of a low Type. The manner in which it
operates has been supposed to be by its Tonic
power, but from many circumstance we
are led to disbelive this opinion. It tends to
weaken the system, instead of being invigorated
by it. Besides these metals are saline remedies
as allum, Salt, Sal Ammonia. The Allum is
the most effectual, Lynde gave it with
nutmeg. I formerly used it with success. It will
probably be useful in Hot Climates. 3 Gr 3 or 4
times in 24 hours. I have never used the Sal
Ammonic but other practitioner have used
it with Laudnum and with success. Muriate of
Soda has sometimes cured it in large doses
Cold Baths have been used with advantage
in long continued Cases. Friction, Exercise is
to be used. Attention must be paid to the diet.

60
Porter is the proper drink, Electricity should
not be omitted when other remedies fail, should
be applied when the Cold Stage is about to occur
probably it acts only by exciting Fear in the
patient. I have never used it. This practice is to
be employed during the Apyrexia. I now shall give
that to be resorted to just before the Cold Stage.
Opium is often to be used just before the Cold
comes on, It may be given in Strong Coffee. 2 Gr,,
of Opium in Coffee without Sugar or Milk will
operate & cause but little Head Ache.
Blisters ought to be employed 6 or 8 hours
before this time. Sinapisms of Mustard & Horse Radish
are not much inferior to Blisters, should be
applied to the ancles or Spine.
The management during the Hot Stage I shall now
speak off. The Bark & most of the Tonics must not
be used, It is this tendency during this stage to
increase the arterial action. There are however
some reputed Tonics may be given with safety
during this stage. Arsenic is one. This is a

61
advantage it has over Bark. The acetate of
Lead also is sometimes used and with entire
safety. Dr,, Lynde speaks of the safety of giving Opium
in it and also that this is the time in which it
has the best effect. I have had little experience in
the use of it thus nor can I recommended its
use under these circumstances. As it is usually
our intention of inducing Diuresis I think we have
better remedies, as neutral Salts. I have used nitre
principally, in such doses as to nauseate. The
Antimonials are also useful. With nitre I have
sometimes combined Digitalis to reduce the
circulation. The Antimonials I use with nitre.
The James, Powder (Antimoniated Phosphate of Lime
containing some Tart. Emet.) is very useful, as a
diaphoretic. James. gave it as preparatory to the
administration of Bark. Most of the Fever in
England are of the Intermittent Type or incling
towards it. Dr,, Hunter used 5 Gr,, every 3 hours,
of James. Powder. It was the opinion of James,
Cullen and others that these remedies should
nauseate and I find this opinion is corect

62
by my own experience. The Cold Bath is used
in the Hot stages of this Fever, but some care is
necessary. More remarks upon it will be made
in the Lectures of Typhus. Bloodletting in this
disease has caused much difference of opinion.
I have never met with a case under any form
that would yield to this alone, whether it
appears under local inflammations or general
kind, but when the arterial action is great
much heat, head ache &c,, it will often be of
use. We must not form our conclusion of the necessity
of this remedy from the Hot Stage alone, but
must observe the cold & sweating stages, the
character of the prevailing diseases, the country
in which the patient is. Some patients will
sink down immediately under it. Topical Bleeding
will often be useful to releve the Head ache &c,, ,
Cathartics are useful to preceed Bark particularly
when the Stomach is irritable & will not bear the
Emetics. The favourite cathartic in this place is
Calomel & Jalap combined. When the Stomach

63
is irritable I prefer Calomel & Rheu combd,,
I also use the Podaphyllum with calomel in
from 20 to 30 Gr,, of the former. It seems to have
a specific action in this Fever. Where there
is constipation Cathartics may be given in the
any part of it, generally may be used in the
intermission if it does not interfere with other
remedies. They seem to shorten the Hot stage
when given in it. Calomel has been recommend
& in those cases with visceral obstructions is
very useful so as to induce a slight but a
constant Salivation. The power of Bark is
promoted by it. A profuse salivation is
hurtful.

64
Continued Fevers
A complete continued Fever is rarely to be met with.
Cullens definition was, Fever without intermissions,
which do not arise from Marsh Miasma, They have
exacerbations but not distinct paroxysms, they occur
Twice in 24 hours. He divides them into what he
calls genera as Typhus, Synocha & Synochus. He
says they do not arise from Miasma of marshes
but this incorrect; they do often arise from it &
His considering them as distinct Genera is also
improper, they are only varieties.
Typhus.
Cullens definition is A contagious disease, Heat little
above the natural temperature, pulse small, weak,
& usually frequent, Urine not much changed, the
functions of the Sensorium much disturbed with a
prostration of the muscular strength. The two diseases
of Typhus & Yellow Fever of Authors are but little
different except owing to some local causes. The
former is contagious the latter is not,
It is often difficult to fix the time of the duration of
Typhus, A person may labour under it sometime without
knowing it while he remains in his chamber but as

65
soon as He comes to fresh air the disease for the first
time will make its appearance. He will become
affected as if intoxicated. This was several times
observed in the Yellow Fever. Often the symptoms
come gradually for several days, with much
debility, lassitude, often difficulty of breathing
loss of appetite, nausea & vomiting, countenances
pale, Head ache, sleep unrefreshing. & disturbed
Sometimes there are murmurings in the Head & Ears
pain about the eyes, a chronic inflammation of
this organ. Face bloated, throbing of the carotids,
As the disease advances these symptoms become
strinking and obstinate. Voice becomes slow, the
lassitude increases, subsultus Tendinum, a pain
of a dull kind in the pit of the stomach, sometimes
vomiting of Green matter, putrid Blood, or Coffee -
Grounds. Tongue somtimes dry, oft appears as if
covered with Red Chalk. Skin is usually [crossed out] parched,
though occasionally great sweats may occur,
Petichiæ may appear but they indicate no specific
disease. The Breath and secretions fætid, Teeth &
Gums black and covered with sordid matter.
The duration of the disease is uncertain. It

66
terminated in 48 hours & has at other times
continued 6 weeks and longer.
Prognosis. Is very uncertain, A gentle Diarrhaea
and Diaphoresis in the latter stages, a natural
Salivation, swellings of the Parotid and other
glands and deafness if it occurs not to early
may be considered as favourable.
Black Petichie, violent diarrhae, gangrene of
Blistered surfaces, are unfavourable,
The Predisponent Causes, are those which
weaken the system, former Typhus & Intermittents,
debilitating passions, Cold.
Occasional or Remote Causes, Marsh miasma
Putrid Animal food, Fear, Cold, with the sudden
abstraction of Heat, Specific Contagion The effluvia
of other animals than man.
The Proximate Cause I shall not attempt to
explain. The idea of a putrid ferment in the
Fluids is incorrect. Hunter says that the bodies
of those who die of Petechie putrify very slow
Sir J. Pringle divides this Fever into 3 Stges.
The First, as long as the patient can go
about.

67
The Second when he is confined with more
Fever till the pulse & action begin to sink.
The Third is more Strinking pulse sinks &
other bad symptoms come on.
In the First the patient should be removed from foul
air. Emetics are useful, full vomitings have
sometimes removed them. They are not always
useful, the nausea may often be removed by
other remedies. Mild cathartics & [diaphoretics]
may be used occasionally but active
purges are highly injurious. The Ol [Ricini?i]
some stimulant drink. Rhee in small doses
Calomel with caution. Salivation is often
useful, even in the first stages is to be used
in the form of the Blue Pill.
2d,, Stage. The Pulse is sometimes full & a
moderate Bleeding may be taken without
harm but must not be repeated. The
Pulse will fall & cannot be raised, the
delirium will be increased. In many cases
as in the Spotted Fever even small Bleedings have been
hurtful. In this stage an Mild Emetic may
be used especially if nausea prevails,

68
3d,, Stage. Pulse has sunk, low delirium, and
Petechia have come on. This stage is the
longest. The pulse must be watched, &
stimulants given. Opium is required not
so much as a mere Stimulant but to
calm the system. The Carb. of Ammonia.
1Ʒ rubbed down with 11Ʒ [with] Gum Arabis &;
Sugar each, with VIII ℥ of water, a Spoonful
every 2 hours. is an useful Stimulant.
Campha is also an useful Stimulant in this
stage. Opium is the best to relive the Subsultus
Tendinum, Campha & Opium answer best
when combined. externally applied Campha
is useful for the Gangrenous sores on the Back
I think it may be used in earler stages
and is preferable to Opium. Musk is oft
useful for the Subsultus Tendinum. Also
Castor combd with Opium. Assc Lactada I have
found it highly useful rubbed down with
Sugar & Gm Arabic about 1Ʒ in 24 hours. It
relieves the Subsultus Tendinum and is I think
the best of Stimulants. The Cinchona though
valuable I cannot speak as highly of as

69
I could wish. It can only be used as an
Auxillary. is to feble to arrest the diseased
action. is apt to be disgusting to the Stomach
The Aristolochia Serpt,, is highly useful in this
disease as soon as the pulse begins to sink
combd,, with the Bark is a good remedy.
The Cort. Angusturia owing to its stimulating
property may be more useful than Cinchona
The Magnolic Bark is worthy of attention
The Cascarilla has succeeded when Bark has
failed.
The Typhus of Camps cannot be well treated
without Wine. Is useful in the third stage
Pringle used it with success combd with
Panada. It may often be given very freely
I have injected it into the rectum with
decoction of Bark. The Port Wine I think
preferable to the Madeira, its effects are
more permanent & less diffusible, but in
some cases the more diffusible is to be and
Good Porter is sometimes better than wine
More potent Stimuli are successful in sour
Typhus Gravior. as the Brandy _ they are

70
are even given in very large doses. Pepper
& Ginger have been combd,, with Brandy.
I have usually used wine, wine whey & Porter,
I have had but little experience in the
use of Arsenic in it but it has been and
said with success. as New England Petecheae
Fever. In those cases that seem to have an
Intermittent Type I have used it with some
advantage. Should be used with much caution.
Opium allays the delirium, Tremors & Subsultus
Tendinum. The delerium resembles a Phrenetis
but is relieved by opium. The Subsultus is
best treated with Opium As a mild Diaphoretic
is often useful, I usually combine with Ipecac.
I am less attached to opium than formerly,
As a mild Stimulant I think other remedies
preferable particularly the Vol. Alkali. The
Nitric Acid when the Bark disagrees has been
recommended, I have not used it.
Semicupium is often useful. Blisters in the
earliest stages are useful as evacuantes; in
the advanced stages will do hurt unless they
are used so as to be [illegible].

71
Dr,, Cullen thinks they may be used at any
stage, but in the declining stage they will do
hurt. Dr Fordyce found them in some cases 
to induce Subsultus Tendinum. Dr Home gave
the Tinct Cathardics internally, In a few cases
of Typhus I have used it with some success,
From 20 to 30 Gt per day may be used.
Sinapisms prepared of mustard, meal &
vinegar are highly useful, should
to the ankles, wrists & elbows. I use them
weak, 3 parts of meal to 1 of Mustard, so that
they may be continued long time.
The use Cold Water is useful. See Curic,s
Reports. In the first stage it should be used
at the time the exacerbation of the paroxysm,
at 9 or 10 O clock P.M. It currics rules be
attended to no injury will be done. In the
least sweat will do hurt. May be used in
sponges & Towels. On the Northern Lines, a
solution of Corrosive Sublimate nearly saturated in Brandy has
been used with success by the Physician
of the Army. Cold water may be used
as drink with some limitations, with

72
attention to the patient. This would have
been highly useful in the yellow Fever
[had not] but prejudice of education
prevented its use.
Salivation by the Blue Pill, or Calomel
& Opium will produce striking good effects.
I have found little difficulty in producing
it. In the advanced stage of
He should not be permitted to be much
out of the horizontal posture, its effects
are great on the arterial
A Diarrhaea must be kept within bowells
by the chalk pulp but it is unsafe to check
a Diarrhaea with strong astringents.
Abscess of the Parotid Glands is a good
Symptom. An irregular Intermittent sometimes
succeeds this disease, Bark & Arsenic would
be useful.
Food. Patients have a great desire for
salted food and small quantities have
a good effect. The drink may be of the
mild kind as Barley water.

73
This disease mixes itself with many other
affections. Intermittents of all kinds, continued
Fevers, Phlegmasia, Exanthema, Profluvium,
Dropsies, & Neurosis often blind with
Typhus or become entirely Typhus.
Yellow Fever
Cullen called it the Typhus Icterodes, but he
knew little about, This yellowness of this is
not at all essential though usual an
attendant symptom. I shall not atempt to
give a Short definition of the disease, it occurs
under many forms. I shall give you Dr Leniry
account of it in South Carolina. He says it is
"A Fever continuing 2 or 3 days, terminating at
that time, with yellowness of the skin, &
nausea & vomiting, is an infectious diseases,
there taking it who came into the town,
while those of the inhabitants who dwelt
then were not affected. White People from
cooler climates, Indians & Mulatoes were
affected with it. The Negroes were not
affected with it. that a person is not apt
to have it twice," In Philadelphia the

74
Blacks were less affected with it "The
Fever commenced in August and ended in
October. The weather before was the hottest
that we ever have known." In this city we
are convinced that it was not much
influenced by the weather "Head ache &
weakness of the limbs usually was perceived
for something, a chill came and then the
Fever. A throbbing of the Carotids, heat was
not oft above 102° of Farenheit in some was
less, was usually distributed to the system.
Skin generally moist, with considerable sweats,
Respiration not much altered. Tongue was
of a cream Colour, Thirst not often great.
Nausea & vomiting usually came on about
the 3d day, A Billious vomiting on the first
day was favourable. On the 1st day were
sleepy, a great dispondcy, with prostration
of strength, face flushed, light could not
be bourn, eyes inflamed," Blood not
inflamed when drawn was never sizy in
this city "Stools dark & foetid, urine pale

75
and in large quantities, on the 1st,, day, Bloody
urine was discharged sometimes about the
3d,, day. No critical discharge was to be
observed when a favourable termination took
place. After the [??cess] of Fever the pulse was usually
small but hard, the heat did not much exceed
the natural heat, skin dry in cold, & clammy
in hot weather, at this time little thirst was observed
vomiting & retching commenced, inquietude
great, sleep short and uneasy, some slept from
the beginning to the end, in others the jactation
was surprising but the patient was insinsible,
debility so great that by raising the patients
head the pulse would sink. delerium now
increased also the inflammation of the eyes
with yellowness of the White of eyes. Petechia
sometimes appeared, uterine Hemmorrhages, also
from eyes, nose & parts blistered, obstinate
costivness continued in some, in others a
Diarrhaea, Urine large quantities, sometimes
bloody which increased as the pulse sunk. Then
symptoms often continued till the 7 or 8th day
when they usually got better or sunk under

76 
this terminated the second stage. The
patient if no change for the better took place
subsultus tendinum, picking of the Bed Clothes
& at last convulsions terminated the disease."
Dr,, B. account.
On the origin of this disease I shall say but
little, the subject has been fully discussed.
but a calm discussion has never been given
to us. 1st,, It has been said that it was
unknown in America before the introduction
of the Whites. There were no physicians to
note them if there had been a similar disease
but we have sufficient testimony from the
savages that malignant Fevers have been
among them. In Massachusetts it spread
among the savages and swept off a vast
population about the time the English took
possession of that Territory.
The opinion of American Physicians may be
refered to 2 heads. Some suppose it to be
introduced by commerce from other countries
Others that its origin is indigenous.

77
In 1793 it was supposed to be introduced
into Philadelphia from St Domingo; the French
physicians in this place first doubled its
importation. Dr Rush was the first of the
American Physicians who upheld the idea of
its domestic origin which doctrine was altogether
unpopular. He ascribed it to some heaps
of damaged coffee in 1793 but I am convinced that
this Fever was spreading round us for a
month before it was much noticed. I
was called to several cases and pronounced them
as such before any notice was taken of the
disease. I recorded them in the public Dispensary
where they may now be seen described a month
or two before the Coffee was placed on the
wharf. Those who espoused the opinion of its being
a foreign one say that no such a disease was
known in such a climate unless introduced by
commerce but this I have shown to be incorrect.
Dr Rush has shown that a similar Fever has
very often arisen from the putrifaction of animal
& vegetable substances, I have known several
malignant Fevers arise from such causes.

78
A fatal malignant Fever prevailed in New Spain
following an immense swarm of Locusts or
Grasshopper. I believe the Yellow Fever to be both
a native of the U.S. and the W. Indies.
In 1793 I joined with Physicians that it was
highly contagious but so many facts have
now arisen that I am fully convinced that
it never communicates from one person to another:
This is now the prevalent opinion in the U.S.
among the Physicians. Dr,, Rush was the first
that rejected the idea of its importation. & of
its contagious nature. This noncontagiousness
of this Fever is what prevents me considering it as
similar with Typhus, the latter being contagious.
Favourable Symptoms were, calmness of the
Stomach an early spontanious diarrhaea,
little anxiety or pain at the Stomach, little
affection of the Head, Slight Hemmorrhagies.
a spontanious Salivation, scabby eruption about
the mouth, sneezing, a steady mind.
An irritable & highly disturbed Stomach.
vomiting mucous tinged with Blood, Black
vomiting, (always fatal only one exception):

79
great uneasiness, obstinate costiveness, Hot &
dry skin, Petechia, delerium early, a rapid
passage from the 1st to 2d" stage, bloody urine
Subsultus Tendinum were unfavourable.
The yellowness of skin I do not consider as
very unfavourable, It usually imagined that
it is caused by absorption of Bile, but this
I consider as incorrect. I have often tasted
the Serum of the Blood of patients highly
coloured & not the least bitterness was to
be tasted, Others tried the same experement
with a similar result. We know the Liver
is much affected but we know that many
poisens cause this yellowness without any
affection of the skin. The yellow colour often
appeared in this Fever not till the patients
were expiring. It is not probable that this
action of the Lacteal system could then be carried on.
Perhaps the colouring matter may be considered
as causing it. I think it is independant of
Billions absorptions. I never have discovered
the bitterness in the Serum of patients with
Jaundice. Dr Rush considered the yellowness as

80
a very fatal symptom. Some great constitutional
change must take place in the atmosphere in
the wide spread malignant Fever, so small
local causes as heaps of coffee could not
have extended their effects as far as the Fever
extended in 1793 in Philadelphia,
Cure. When it first appeared as a general Fever
in July & Augt,, 1793 it was considered as a
Putrid Fever (so called) It was therefore treated
with antisceptics & Tonics as Bark, wine, Elixr.,
vis, but after a short time it was found
necessary to lay aside their use. In all the
forms that Bark could be used it was of
no service, and was soon rejected by the
Stomach. Perhaps if the disease should again
appear it may be under the Typhus Type.
We find that in South America the Bark is
highly useful, in the Yellow Fever. In the
West Indies the Cert, Augusturia was given
after evacuations and with the reduction
of the symptoms. The Magnolia Trepetalla has
very semilar properties with the Augusturia.
The Elix Act was offensive to the Stomach.

81
Not until September was the disease well
understood, The Lancet was resorted to, Dr
Barnwell first bleed & with success but met
with much opposition Dr Rush did not
use the Lancet till he saw the result of
Dr B.s practice. Other physicians Bleed in
small quantities & used other remedies
Perhaps in some cases vs,, was carried to
far, Dr Rush found the pulse to rise after
vs,, and his doctrine on this point was much
opposed by many Philad,, Physcians. This
practice & a knowledge that it would raise
the pulse was known to some of Sydenhams,
pupils, particularly Dr Dover. Dr Rush
found it reduced the frequency of the
pulse & assisted cathartics. I have no doubt
but it assisted the cathartics, in other
diseases has similar affect. Dr R. found it
to relive delirium, induce diaphoretics, &
reduces the inflammation of the eyes. Many
of my patients recovered without vs,, at all.
Bleeding did not relieve the distress of the
Stomach & Head as could have been expected

83
Obstinate costiveness usually attended, we
used Calomel, Ol Ricin, Jalap, &c,, Dr R,
gave Calomel & Jalap a.d. 10Grs,, Purging
corrected action of the pulse, raised it
when low, strengthened the patient in many
cases, though many times the reverse.
He gave it at night when a paroxysm
was expected before morning. He says that
purging tended to prevent the vomiting. The
stools had great acrimony in almost all
cases, hence purgatives were proper, but I
think mild laxatives would have often
answered better than the drastic ones often
used. The French Physicians used the Ol Ricin
& Sulpthate of Soda. The American Physician
often did to much, the French not enough,
Emetics were much less used than Cathartics.
In the West Indies they cause a vomiting which
cannot be arrested till they terminate in Black
vomiting. In 1793 Dr Rush did not use them,
in 1798 he tried them but with no success
Diaphoretics are remedies of much importance,
It assited other remedies, I In 1793 I did not

83
use Dovers Powder but in subsequent Fevers
I found sudorifics useful. In 1795 I used
the Antimonial preprations. Dr Rush was
opposed to the Antimonials. considering them
as too weak but very improperly. The
Eupatorium Perfoluatum was used with
success. In 1793 Cold water was a little
used in the Hot Stage but not often enough.
It was gratetul to the patient, removing the
heat, pain in the Head & causing sleep, as
soon as the sweat broke out the water
must be withheld and the sweat encouraged
by mild drinks. Cool air was useful.
The diet should be mild and vegetable
in the first stage. This diet would not
secure the constitution from an attack
but seemed to be predispose to it. The cathartics
were the most useful of all remedies. The best
diet was that to which a person was accostomed
Blisters were used in the first stage to
evacuate in the others were not as useful
was expected. A Blister over the Stomach
abated the irritability of that organ.

84
They were not useful till the system was
depleted. Opium was hurtful and dissagreeable
to the patients, it seldom gave refreshing sleep,
but rather increased the disturbed symptoms,
It increased delirium. It was found by [Col???i?]
that Opium increases the Bile in Animals.
Dr Rush used small draughs of sweet milk
for the vomiting & burning in the Stomach, if
these failed he gave Ol. Oliva. Lime Water
& Milk combined seemed to allay the Black
vomiting. I Knew one case caused by Cream
of Lime. Magnesia was largely used by
the French Physicians. To allay the irritation
of the Stomach I gave the Vitriolic Ether.
with considerable success, in vomiting but
not in Black vomit. It had been said that
Cayenne Pepper has been useful in the W.
Indies in Black vomiting. The Acetate of Lead
promises to be useful. Dr,, Erving of Charlestown
informed that he had cured several after
the Black vomit had come on. A Salivation
has been said in some cases to be useful.
That whenever the Salivation could be

85
procured the patients were safe. I saw
several cases combined with Dysentaries.
Several of my patients were salivated
and not one of them died, I have an
high opinion of mercury in the cure of this
disease. I think the chance of cure in those
who were salivated was as 96 to 100,
There were many recoveries without any
treatment was given by Physicians. Nature
did a great deal in cure.
Hectic
Dr Cullen considers it as a symptomatic
Fever. A fever returning every day, with
accasions every morning or evening, with
night sweats and sediment in the Urine.
The disease is of a specific kind arising
from causes different from those of the
Intermittent. Is attended with increased
heat and pulse, gradual wasting, a
composed mind, full of hope. Is [unproc???]
by any notable chill in many cases
though somtimes approaches to the
Intermittent. These symptoms are after

86
eating flushing of the face, heat in the
palm of the hands, Fever increases towards
night, Sweats at night often accompanied
with Diarrhaea, Is usually symptomatic
but is not always connected with any
visible cause, may follow great evacuation
of Blood, Salivation, Diarrhaea, onanism
of Milk, Fluor Albus, Diseases of Uterus,
Cancer, It will often continue years after
the evacuation of the mensis, Rentention
of the different discharges, will cause it,
May accompany quick growth of children
of, Dropsy. Puss is the most frequent in
the Lungs, Liver &c,, It often yields to mild
remedies when the cause is removed.
Tonics are often the best, remedies even
if they will not cure will palleate.
The Bark is the best of remedies, The
preparation of arsenic is preferable to all
others. Mineral acids are useful. the Sulp,
Acid will check the colloquative sweats.
The effusion of cold water I have never
used except by towels, then with some

87
success. Dr,, Currie used it with some
success, he applied vinegar to the hands
Synocha.
A simple continued, inflammatory Fever
Heat increased, pulse frequent, strong, hard, Urine
high coloured; sense not much impaired.
Notwithstanding what has been said about
it, it rarely occurs, The 3 first days of acute
Rheumatism may be considered as Synocha.
The Antiphlogistic remedies are to be used
II. Phlegmasia.
This turn signifies burning, The symptoms of
[??llan] and Synocha; a topical pain, with
impaired functions of the affected part,
Rheumatism
It may be doubted whether it is always a
true Phlegmasia, is often closely connected
with other diseases as Intermittents, Dysentary
&c,, Owing to its close connection with the Fever
just [crossed out] described I shall place this next.
Symptoms of Cullen are, Most part arises from
external causes, has Fever, pains following [to???s]
of muscular fibers, affecting the large joints

88
increased by heat. He has made several
species, as Sciatica, Lumborum, &c but are
only varieties of the same disease. He has
given several kinds of symptomatic. Perhaps
Gout might be considered as a species of this
disease. Most authours divide it into the
Acute & Chronic. The former only belongs to
Phlegmasia, & will be first considered. They
are not distinct species, only a variety
Is a common disease of Cold Climate though
not confined to them, but is found wherever
there are great vicissitudes of weather. Where
the range of the Thermometer is small it less
often occurs. In G. Britian occurs oftener in the
Spring & Fall. In the U.S. is most frequent in
the Winter. It is very frequent in vicinity of
marshy grounds, and I believe in Calcarious
Countries. The same applies to Toothache. The
causes of acute Rheumatism are application
of Cold, succeeding heat, topical application
where the most of the body is warm, It does
also arise from the same causes as
produce Intermittent. These two diseases

89
often alternate with each other & run together
Other causes are metallic matters. Does the
Arsenic produce it.? The fumes are said to in
Germany. The Suppression of Gonnorrhea has
sometimes caused violent acute Rheumatism.
A violent pain attacks the Knee or other large
joints, Venesection will not relieve it & nothing
but a restitution of the discharge of Gonnorrhea
will answer. A strong astringent Injection has
produced it in Several cases. It may arise
from suppression of Dysentaries. of Bloody
discharges from healing up of Ulcers & Itch
Redisponent Causes Cold and variable climates
Plethora, High living, Great evacuations, an
irritable state of mind, violent muscular
exertions,
It may be distinguished by its attacking the large
joints, often the viscera particularly the Heart
pain changing about, larger joints most
affected, which serves to distinguish from Gout
sometimes the smaller may be attacked, It
sometimes attacks and continues a long
time in one part. It attacks with a chill
followed by heat and has a paroxysm of Fever

90
full & hard pulse. The pain may preceed
or may follow the Pyrexia. The pains do
not often continue in one joint bony but
changes to others. Exacerbation at evening,
the pain greatest during the night. The
Pyrexia is a true Intermittent. The joints
after a time usually swell & are tender.
Sweating sometimes occurs but is not always
critical. An easy sweating is however usually
beneficial. Urine high colour, at first without
a sediment but this after a while appears.
Blood exhibits the Inflammatory crust,
It is an intermediate disease between Intermittents
& the true Phlegmasia. It may end in an
effusion of fluids, but is usually again
absorbed. The duration is uncertain. It has
terminated in 3, 4, or 5 days, usually continues
10, 15, 20 or more days. The pains may
continue after the Fever ceases but are
more fixed to one place. Seldom attacks
the more vital parts & hence differs from
the Gout. It sometimes seems to attack the
Heart and is usually fatal. The Heart is

91
usually found enlarged. It is the Cardetics of
Dr,, Cullen. Requires attention.
Lumbago is an acute pain fixed in the
Loins, resembles the Nephritis, parts not [illegible]
to the touch, patient uneasy in bed & in
much pain when upright. The Nephritis has
[Ne??????] and numness of the thigh attending
it Sciatica is situated in the Sacrum &
Thigh about the acetabulum. It has laid the
foundation for dislocation & Hip disease,
In puerperal women in whom the milk has
been suppressed it has ensued with violence
[Class] The Negroes of Virginia are almost always
affected with the Sciatica.
Chronic Rheumatism.
Is a variety & for the most part is the consequence
of the other disease. Cullen,s definition is,
arising after common Rheutaim, muscular
[ext??] or sprains, much pain, relieved by
external heat, often cold, no pyrexia, some
swelling. I would consider it as having
some Pyrexia. If the Arthrodia of Dr Cullen


92
[often] [alternate] [and] [crossed out] [together], [other] [causes]
[are] [metallic] [matters] If the pains change places,
with Fever, swelling we may consider it as
Acute, but if the Limb is cold, stiff, & relieved
by heat, without much Fever, pains fixed,
it is Chronic. In the former the natural [illegible]
are affected, in the latter not. the one affecting
persons from puberty to 30, the other from 25 to 60.
We oft meet with intermediate cases, between
the two kinds, so that Dr. Rush divided it
into 3 Kinds. Chronic is found to affect those
joints around which many muscles exist,
Strains, exertions &c,, often induce it: There are
other varieties, as Scorbutic, Rheumatic pains
occurring with the Scurvy, I have rarely
seen it, was very common in the days of
Sydenham. He tells us that Bark seemed to
do harm. The late case in the Hospital I
consider as one, which you know terminated
fatally. It seemed in this case that Bark
was not beneficial and seemed rather hurtful.
Proximate Cause. Some ascribe it to

93
acrimony in older times. Boerhave considered
it as a Lentor or viscidity. Dr,, Gugoin
as an inflammation of the part, which is
only discribing the disease. Dr Cullens
considers it as the same as of Inflammation
Cure. In acute as it is inflammatory calls
for Mild Diet, require much attention. next
is Cathartics & Diaphoretics. The Cathartics
afford much relief. The great affinity of
Rheumatism to Gout is a good analogy
for the use purges. Are peculiary useful
when it assumes the Intermittent. Calomel
with Jalap or Rhei are preferable. Saline
purges are sometimes dangerous where there is
a determination to the skin. Dr,, Cullen drew
large quantities of Blood in the first stages,
He found it necessary to have bounds.
Mere Bleeding will not cure & if too profound
will tend to produce the Chronic Kinds In
many cases is to be used only as an auxillary
& not as a principal remedy. It requires
caution where the system is not well Known
Dr Sydenham prefered Cathartics after One

94
Bleeding. that patients were less reduced &
better prepared to receive Opium. This was
his last practice. Dr,, Fordyce also found
large Bleeding as hurtful. Dr Heberden has
shown that we depend to much on Copious
Bleeding in acute Rheumatism. I am confident
that in young people where it does not put on
much of the Intermittents 2, 3 or 4 Bleeding are
necessary. In the Syphilitic & Metallic Rheut.
Bleeding will not afford relief. Topical
Bleeding will sometimes be of service, when
much swelling & it is fixed to one joint.
Large dose of nitre have been said to be useful.
I have not employed it in this manner. After
vs,, it is given Julep, oft combined with a
little Tart Emetic. I almost always put my
patient on ℥ss or 1Ʒ of nitre in 24 hours, with
Tart Emet. & often Digatalis but it cannot be
given in such doses as the British Physician
recommend; To relieve the pain physicians have
used Opiates. The use of Opium in acute Rhet,,
is a nice treatment. It cannot be used until

95
Bleeding & Cathartics. It does no good unless
it excites perspiration. In Dovers powder it is
useful. It consists of Opium & Ipecac a a
parts with a little Nitre. Bleeding is
usually necessary before its use. If the patient
drinks for an hour [before] after the powdr is
given it will puke This should be particularly [illegible] to. When the medium begins
to produc Diaphoresis wine whey & other drink
should be given. This disease cannot well
be cured without Diaphoretics. Still we are
not to calculate on a cure by a profuse
sweating. [Guac???] is a Diaphoretic, but should
only be used in [Arthradice]. A Sciatica has
been treated, with Opium, Calomel &
Antimonials combined with success by
some practitioners. Other narcotics besides
Opium in this disease, Digitalis exerts
much power over the Heart & Arteries, &
Dr Cullen finds it to be an useful
remedy in acute Rheumatism. I have given
the Tinct with nitre with much success. I
give it as a seditive. After Bleeding &
purges I give Nitre & Tart Emet or Nitre &

96
Digatalis during the day and is very
useful in the most irritative cases of young
people. The Conium may perhaps be useful, it
has been recommended. I have employed
the leaves (which should always be used in
preference to any other part). Stramonium I
have been assured have been used with
success. In metallic Rheumatism I have used
them with success. They allay irritation, in
irritation Buboes are very useful, when Opium
cannot be given. The Menyanthes Trifoliatum,
has been recommended in Europe I have
not used it.
Emetics have been useful, empty the Stomach
reduce the pulse, produce Diaphorisis &
act downwards as Cathartics. Are most useful
in those kinds which assume the Intermittents
Blisters have not had much success owing
to the changing of the pain. In Sciatic &
Lumbaggo are very important. Sinapisms
are not often used, as they produce no
evacuation should not be employed because
are dangerous produce a metatasts

97
Blisters are not applied with safety when the pains
are inclined to shift about.
Different preparations of mercury are used to
excite Salivation and should never be neglected
in refractory cases. In Syphilitic are indispensible
In every case of the Acute it is injudicious
to use profuse salivation. Small salivation often
seem to prepare for cure. In Scorbutic mercury
is improper. Almost all the medicines that I
have mentioned are evacuant, I shall now
mention some that exert this Tonic properties:
Arsenic is employed with success after deplitia
in the Acute Rheumatism. I venture to assert that
in many cases it is a specific. Is suited to
the more acute, is not suited to chronic &
I think rather dangerous. best suited to that
which assumes the Intermittent Type, also that
of the joints & Rheumatism of the Thorax, will
probably afford relief where Bark is proper,
is less apt to excite a phlogistic Death
It will produce its effects in a few days
Cinchona has been recommended by s
We lay it down, that it may be used when

98
is an Intermittent Type particularly during the
Intermission. Before the use of Arsenic I had
cases that I could not treat without Bark.
Some late British Physicians, after evacuations
give Bark at all times of the paroxysm in
small doses. but I think it never should
be used when Fever is present.
Cure of Chronic Rheumatism:
I shall begin with Stimulating remedies.
Various preparations of Guaccum, even in the
acute after much deplition have been of use.
The Vol. Tinct, is a powerful one, is valuable
in the Chronic in the Intermittent during the
intermission, should be given in milk, acts
as a cathartic, diaphoretic & some Tonic property.
Different Balsams have similar effect,
The Terebinths has been more successful.
the following preparation is the best Turpentine
Ol. 1℥ Gum Arabic ℥ss Sugar ℥s Yolk of 1Gr
Water
Vol. Alkali is very useful 2Э or 1Ʒ in
24 hours. Seed of Mustard 1 or 2 spoonfuls
unbruised in 24 hours, is often successful

99
Cantharadies, in Substance & Tinct. are.
often useful. Iron in long continued use
has sometimes done good. Mercurials
so as to salivate are hurtful.
Purges are very useful. External applications
are safer than in Acute though not altogether
safe in this. The Vit. unguent, has been used
with some success. Friction, & Electricity have
been sometimes of use. Cold Bath, occasionally
of use. Diet must be cordial but highly
stimulant is improper. Long continued Blisters
are good. Tinct. of Phytalacce Decand. Birria
is recommended by some I have had little
experience.
Octontalgia
Is properly a surgical case [?whe] the tooth is
carious, If Rheumatic the treatment above
must be followed,
Podagra.
I can speak from my own experience.
Dr,, Cullen,s definition is. hereditary, arising from
without an external cause preceded by affects
of the Stomach, affects some of the joints

100
attended with Fever, often alternates with
affections of the Stomach. Great Sac most oft
attacked. Has been distinguished into
Regular
I shall first consider the Regular, is as
with a sever inflammation, passing off with
much tumour, which relieves the pain & ends
in desquamation. Commonly affects the Ball
of the Great Sac, where it subsides the health is
good, During the attack the Alimentary Canal
or the head is affected, Sometimes attacks
suddenly particularly when powerful exciting
causes have been applied, Does not usually
come on thus but usually a previous
affection of Stomach, considerable acidity
flatuency, costiveness, irresolution, sensation
if cold water was running down the thigh
swelling of the veins of the leg. The Anorexia
is the most common precedent. Is usually
attacked during the night, Sometimes occurs
in the form of Intermittents. & attacks like other
fevers. The duration, Kind, & degree is uncertain.
usually is remitted towards morning with a

101 
little sweat. During the day is not much 
painful, but comes on towards night
Sometimes remains in the part first attacked
but it often changes to other parts. As long 
as the Constitution is sound the larger joints
usually remain unattacked. The Urine
during the attack is high coloured, in the
decline deposites a sediment. Blood is
buffy, Spirits good, intellects are bright,
an itching usually remains after the
disease is ceased. The interval between
the attacks is usually one year, though oft
longer or shorter.
The Irregular often succeed this Regular -
If it attacks early in life it frequently ceases
about 50, Ind Randolph had it at 16 while
a member here. It somtimes attacks not till
the 70th year. It has often removed other very
terrible diseases but it often alternates with
them. After it has long continued Chalky
concretions are deposited. They are Uruate
of Soda. It rarely injures the Mind.

102
Regular, attended with inflammation of the limbs,
particularly of the Great Sac, swilling, disquamation
Atonic attended with much debility particular
of the Stomach, inconsiderable pains in the Limbs.
Retrocedent. with inflammation of the Limbs which
soon subsides and attacks other parts.
Wandering. attacking mutual parts after it has
affected the extremities.
Gout is highly dangerous when it attacks the
Viscera. I am convinced that Gout & Rheumatism
are distinct diseases. In Gout the pain is most
confined to joints of the extremities, but apt, to shift.
if it does it usually goes to another similar
part, parts are usually red. It is hereditary &
most often attacks men. It arises from internal
causes & less evident to us than those of Rheumatism
is [crossed out] [pricu???] usually by affections of the alimentary
canal. It is apt to return at certain periods,
is incurable, Rheumatism is, usually occurs at
later period than Rheumatism. There is a peculiar
inflammation in Gout. "It has all the characters
of inflammation but is attended with many
peculiar characters" Hunter.

103
It comes on quicker than any other inflammation.
Has attacked instantaneously, as on pulling on a
Boot, It leaves parts in a state different from that
in which any other does. Its action must be
different in different parts of the body, as in the
Brain, & Toes. It is a specific inflammation.
It produces similar effects in all constitutions
in which it attacks. I was affected severly
[attacked] with it in London in my 19th,, Year.
It has no tendency to [inflamm] suppuration, &
the chalk stones may remain for years without
exciting inflammation, It is supposed that
Gout & Rheumatism are occasionally present at
the same time. Probably they are.
Predisponent Causes. Are hereditary disposition
which cannot be obviated by manner of living. [??ridium]
or decline of life. When the dispostion predisposes
it may form as early the 9th,, year. I was attacked
in my 17th,, Plethoric habit. but not necessary.
Male sex, but women are not altogether free from
it. but often attacks under a different form,
& the Regular is very rare. Do Chalk Stones ever
Form in Women? _ Early [ve?ely], is a powerful

104
one & tends to cause the irregular, & presents early
evolution of the Regular. Irritable Nervous
System, acuteness of intellectual faculties.
Idiots are not free from it.
Occasional Causes. All kinds of irreg
in regimen, too high condiments, too much wine
& Stimulating liquors, stimulating living, whatever
produces indegestion & acidity in the Stomach,
sudden changes of manner of living as in the
case of Dr Brown, he considered a vegetable diet
as the cause. I attended his last lecture, it was
on Rheumatism, & was attacked with some
symptom of Gout, he took spirits & Laud. &
fell into an apoplexy. The suppression of all
[crossed out] continued evacuation. Spring & Fall, warmer
climate, The people of the U.S. are destined to it.
Violent emotions of the mind, great study,
cold applied when the body is hot, some
suppose that it is owing to lead drank in Wines,
I think the [wak???] of metals are more subject
to it. Is not Epidemic. is rare in the Tropical
climates. Is it contagious? I do not believe it is.
Is not a local disease, may affect any part.

105
It may make its appearance in families that
are not predisposed to it. But this is rarely
the case & some doubt whether it ever occurs
It has appeared in the shape of Gonnorrhoa,
Hydrocele, Epilepsy, Pertusis & Mania. Various
opinions have been entertained as to the intimate
nature of the Gout, some suppose it arises from
an acid, some from an alkali. The former is
the present idea in France. They are futile
notions. I do not mean that Gout is never
connected with a morbid state of the state
with a great access of acid. The lentor or
acrimony in the nervous fluid has been
advanced. None of the theories are satisfactery
still are without any Knowledge of its
nature, Authors differ about its seat, I believe
it not essential to any system but it seems to
have most connection with the nervous; the
Sanguiferous is also much affected, Dr Keenly
considers it as not different from common
inflammation but differs only in the peculiar
part in which it is seated, the ligaments.
But we find that it attacks the Brain

106
Stomach Heart &c,, which are not ligamentous
I think that persons predisposed to it often
escape a paroxysm when the have sweaty
feet. They seem to escape Epidemics except the
Catarrhal affection
Indications are to attempt to prevent the
return of paroxysms or lengthen the time between
them 2d,, To shorten the duration of the paroxysm
We must investigate the symptoms.
The method in the first is to avoid the
predisponent & occasional causes; a diet
of vegetable containg Farina, milk, little
animal food, avoiding Wine, use evacuation
as bleeding, diaphoretics, purges & sometimes
drastic ones. Blisters, Gestation, Friction, a
cautious use of Cold & Warm Bath, Labaur is
too frequently recommended, in broken constitution
violent exercise should be avoided, a
calm mind, regular hours, avoid venereal
connections. Warm climate favourable, when
the Thermometer. In Broken Constitutions the
Strength must be supported by animal food
& good Wine, & sometimes strong drinks

107
a free perspiration by gentle exercise, flannel
dresses. To obveate debility & acidity of the
Stomach Bitters, Tonics &c,, should be used.
The Ginger Tea was used by Sir Joseph Banks
with advantage, Ginger boiled in Milk.
Emetics sometimes. Portland Powder is
small doses may be used with advantage.
Cases of misplaced Gout is common in the
Northern & Middle States, which is not owing
to its use as Dr,, Cullens supposes. Will afford
relief to the Gouty Constitution. Dr,, C. supposes
it acts by strengthing the Stomach for a time
but at length weakens it, and causes the
misplaced gout. All sudden changes of diet
should
2d Indication. We must attempt to carry it
off without its changing to some other parts
Cathartics, Bleeding, light diet, Fur dress.
All the stimulants are precarious, as Opium
Camphor, Stramonium &c,, are apt to [ha?????]
[it] to more vital parts. Warm Bath is also
danger, also Cold Water topically applied is
also dangerous. The last was Dr Keenlys

108
treatment. I could mention several cases that have
proceed this without falling a victim to it.
but still it is highly dangerous. It would
be easy to collect numerous fatal cases.
Apoplexy very often ensures very soon after
its use. I protest against the use of cold
in every form in Gout. During a paroxysm
when the Constitution is debilitated Cordial
food & drink, sinapisms may be used.
When it attacks the Stomach the warmest
cordials must be used, great doses of
Opium. I have used 4 or 500 Gt of Laud in
a few minutes, Ether Brandy, musk, vol
alkali, friction &c,, and attempts to bring it
to extremities must be tried. Camphor
externally applied is most dangerous [illegible]
in regular Gout, but it is proper to apply it
to the affected part in misplaced Gout,
When it attacks any viscera with much
fever the antiphlogistic remedies must be
used freely. In 1812 I was attacked in the
Lungs in the shape of Hemephysis & I saved
my life by bleeding freely after I had

109
discharged 3 pints of Blood from the Lungs.
I have had no [practice] experience in the
Medicated Water. I learn that it has now
nearly gone out of use in the France & England
because of many sudden deaths having
immediately followed its use.
Nephritis
Is common where Gout & Rhematism prevail.
Cullen,s definition is a febrile disease, pain in the
region of the Kidnies, following often the direction
of the ureter, frequent discharge of urine, with
a retraction of the Testicle. Fever is a Synocha
pain pungent & pulsating. The pain shoots along the
ureter, a sensation of creeping motion along the
spermatic Chord, a numness of the Thigh is common
in symptomatic. vomiting is common in the [illegible]
vera, Urine is commonly of a red Col
The Remote causes are falls, violent walking
acrids taken into the system as Cantharidies
Ol of Terebenth & sometimes Camphor, Acrid [D???t?]
improperly given as Squills, perhaps Digitalis.
A cuculi is the most common remote cause.
The inflammation may terminate in the common

110
methods. Suppuration continued sometimes usually
ends in Hectic. The abcess may point outward
but is usually fatal. Gangrene is also the
[???usation] in many
Treatment: Bleeding, mild Cathartics, fomentation
Warm drinks, infusion of Uva Ursi, vomiting is to
be moderated by Barlly Water & Chicken Broth.
A Blister laid over this region would often
be highly useful & not dangerous, after vs,, &
Cathartics. Opium may be given freely. When it
is owing to a retrocedent Gout Blisters to the
ankles will recall the Gout to the extermities
Cystitis
A febrile disease like the one just described
a Tumour & pain in the Hypogastric region.
sometimes a suppression of Urine. It may be induced
by the use of astringent injections or acrid [d????te]
Cure large Bleedings, mild cathartics, emmolients
fomentations. Would not a Blisters be useful.?
Cathartics must be used. Digitalis has been
of great service, superceded the use of this
instrument, Infusion of Digitalis & Tobacco is
worthy of attention. If owing to Gout Blisters

111
must be applied to the ankles.
Hysteritis
I have little to say about it. The os uteri painful
to the touch, pain in Hypogastric region, & fever,
The puerpural Fever is disposed to take on two
very opposite forms, one very violent inflammation
the other a Typhus. The one requiring very large Bleedings
the other cordials, as wine, opium, also Blisters,
The use of Camphor I cannot suppose is adapted
to the cure of this disease generally, probably a
to be used in the [latt-] Typhus Kinds.
Splenitis
I can say nothing from my own experience is
rarely ever met with. Fever, tension heat &
tremor in the left Hypochondric region. A
suppuration sometimes ensues in this viscus
without much previous pain. Requires the same
treatment as inflammation of other viscera.
Hepatitis
The Liver is subject to many diseases, the
inflammation uses this name. Cullen Defines
it. Pyrexia, with tension pain in the right
Hypochondric region, pain in the right

112
shoulder, difficulty of Breathing, pain is usually
increased by pressure, is sometimes acute but
oftener is obtuse. It has some resemblance to
Pleurisy. Pain increased by Inspiration, it oft
goes to the shoulder and often between the
Shoulders. In Women Dr Rush, said it oftener
attacked the left shoulder, but I do not find
it the case by my own experience. The pain is
sometimes found in the left Hypochondriac region.
The pain in the shoulder is not a pathognomic
symptom, it attends other affections, a difficulty
of lying on the affected side attends it, Cough
vomiting, a yellowness of the eyes or skin are
often observed. Pulse frequent, hard & oft
intermitting. Intermittents have occurred
under the form of the disease. It affects both
sexes, found oftener in men because men experience
to exacting causes. The fever is phlegmasic.
It has alternated with a Bronchocele in a
young Lady of this city. Men are more liable
to schirrous Livers. Other animals are affected
with it, the Hounds carried

113-
Remote Causes. Such as produce Dysentar
Intermittents, Remittents, Rheumatism. Cold
applied to the body, has caused it. It is caused
oftener by the causes that induce fevers. In
Bengal strangers are almost always affected
with it. Fractured Skull has caused it. the
Hydrocephalus has often caused, acute Gout
may lay the foundation of it. Accidental
hurts on the region of Liver. I do not consider
it as infectious. It may be symptomatic or
original. The diagnosis is often uncertain. The
pain in the left shoulder may be owing to an
affection of the Spleen. The Liver has been sound
when effusions have only a little misplaced
it, and the symptoms would lead us to [con?i??]
it as a Hepatitis. The Lungs have been diseased
and the Liver it has been supposed to be an affection
of the Liver. Like other Inflammations it may
terminate. The resolution of it is attended with
some evacuations, Bleeding from the Nose or
himmarhoids. Diarrhea. sweating, sediment in
the Urine. Erysiplas in some external part.
When it ends in suppuration the pulse may

114
be discharged by Billary ducts, externally, or
through the Diaphragm into the Lungs.
Cure. Demands the remedies for active Inflammation.
Venesection often repeated, quantity
regulated by Fever, the pain, strength of the patient
pulse &c,,. When there is much cough it requires to
be taken frequent & largely. Topical Bleeding is
useful. The Blood shows the inflammatory crust.
Probably in enlargements if this viscus which are
often considered as Chronic. Bleeding would
dissipate them. Large Blisters in Hepatitis are
to be used, frequently applied on account of
their evacuating properly. Purging & sometimes
strong Cathartics are required. The Ol Ricin
or Tamarinds & Crystals of Tartar are usually
to be used. Enema are to be used. Rhei
& Calomel are also sometimes to be used. I
have used Digitalis & Nitre combined in the
acute Hepatitis. Mercury is very important
in this disease. its utility is established by
experience; particularly in Hot Climates. Must
not be given in the first stages & not till the
evacuations have been made. It may be
employed with Opium that is given internally

115
A single salivation may fail but two or three
will usually cure it. A Salivation is to be
excited though in some cases it has had
no sensible effects on the mouth. I have
seen the disease cured without mercury, but
this medicine seems to be particularly adapted
to the Idiopathic. Nitric Acid has lately
been recommended & it has been used in
some cases with advantage when mercury
had failed. The Liver is sometimes ruptured
& hemmorhage kills the patient
Chronic Hepatitis
It often exhibits none of the symptoms of acute
Hepatitis. It may follow the acute, tumor
in the side, with obtuse pain increased by
pressure. It may be caused by long continued
grief, strong drink. Blisters to the part,
cupping, Cathartics, Slight Salivation, are to
be used. No symptoms have discovered this
disease in some cases while the patient was
living but on dissection large collections of matter
and many marks of former inflammation
have been discovered.

116
Icterus
The Jaundice & Hepatitis are nearly connected
If the former is not always attended with Fever
it is in many cases, It is sometimes a Phlegmasia.
Dr,, Cullens definition is attended with a yellow
skin & eyes, whitish Feces, urine obscure red colour
colours linnen yellow. He has several species.
The first is that attended with a Billiary Calculi.
has pain, increased by eating.
The Second is spasmodic without pain.
The Third is Hepatic. or Liver Jaundice without pain.
The Fourth is that of Pregnant Women.
The Fifth is that of Children first born.
The countance of whole nations of People I consider
as depending upon the Liver, it is through the
agency of the Bile.
The jaundice always shows yellowness on the skin
partecularly in the whites of the eyes. Feces are
changed to whitish hue. Their natural colour is
owing to bile. Constipation of the Bowels is
often [illegible], though sometimes attended with
a Diarrhea. Urine high coloured, trying [pap?]
[illegible] Gamboge. The Serum of the Blood is

117
also coloured. The patient is attended with
lassitude, uneasiness, pain at the Pit of the
Stomach, & loss of appetite. The pulse is often
slow & natural when the pain is severa & acute
at the pit of the Stomach. Chills often attend
the disease. This disease is preceeded by the
common symptoms of Fever + It has prevailed
Epidemically in this city. The taste is vitiated
often bitter. It sometimes attacks suddenly not
usually, attacks both sexes. [alike], but I believe
women are the most liable to it. That of Children
is not usually formidable. Persons affected
with yellowness of the eyes sees every thing of a
yellow Colour, it is not always the case, but I
have seen several instances. The Theory is of Jaundice
is plain. Whatever interrupts the passage of Bile into
the Intestines. The most frequent is the Biliary [Ca????]
It is attended by the most severe pain. The
obstruction may exist either in the common or
Cystic Duct. The calculi will remain in the
Bladder without causing Jaundice. Worms have
obstructed the ducts, The have been found in
the Gall Bladder; Spasm is supposed to be the

118
cause of Jaundice, and is occasioned by a
peculiar state of the Mind, It seems often to a
periodical disease. Experiments have shown that a
true muscular irritability exists in the Ducts,
at least there is a cellular contractily & I
think this contractily will admit of something
like spasm, We frequently see Jaundice occur
very suddenly in Hysterical women, It may
arise from a permanent stricture of the duct.
Dr Darwin supposed that an insipid Bile would
not stimulate the duct & would remain &
Crystalize there. Probably is only a production of
imagination. The accumulation of Bile in the
Bladder is not necessary to cause the Jaundice
it existed in a woman who on dissection
was found not have any Gall Bladder. [It]
[crossed out].
It has arisen from a wound of the Bladder in
which the Bile was thrown into the abdomen
The patient lived 17 days. It has been disputed
how the Bile gets into the circulation. The
Lacteals have been found filled with Bile or
dissection in several cases.

119
The thing is proved that some active substances
may be absorbed into the circulation. Mr
Bichat injected Bile into the circulation of
a living animal & in several cases proved
hurtful but on further investigation & Trials
it was found that it might be injected.
without injury. The true Bile does not
exist in the Fluids in Jaundice, it is not
Bitter, it is void of the common properties of
Bile. It may only contain the colouring
matter. it may be changed in passing through
the Glands. Biliary Calculi are divided into
6 Species. 1st, Hepatic Calculi. 2d,, Hepatic
Adoposed, 3d Cystic 4 Cystic Cortical, 5 Cystics
Adiposed, 6 All are soulable in alkali
soap, oils, & ether. They obtain [illegible] a large size
in some cases 3℥ & 4Ʒ one has weighed. They
sometimes cause hemmorrhage.
Cure. Sometimes Jaundice is cured by Bleeding
is required when much pain attends the
passage of the calculi. Cathartics particularly
when there is costiveness. Mild ones are
to be used particularly in children, Pregnant

120
women, & weak constitutes. More powerful
ones are sometimes required particularly Calomel &
Rheu combined. Drinking warm water, from
1/2 a pint to a pint every morning - Emetics
useful. the best is Ipecac in 16 to 20 Grs [illegible]
It will often be necessary to put the patient in
a warm Bath during the operation of the Emetic.
Would not Tobacco externally applied be useful
When much pain fomentations may be applied
Blisters are useful often Cathartics, A Salivation
by Calomel has often done service. When
it is occasioned by pressure of neighboring
parts it will be difficult to cure. The
Vol Alkali given freely has been recommended
The Muriatic Acid has been used in Maryland.
Opium will be necessary to relieve the pain
in many cures. A powerful itching will be
troublesome, Other narcotics have been used
with advantage. Particularly the Conium.
Certain vegetables as Leontactor are said to be
of service. Dr Rush, van Sweiten, Monroe were
convinced of its utility. The Birbery I have
not much faith in. Exercise is useful. Bark

121
has been recommended, it may be useful when the
disease depends on weakness or the fever puts on
an Intermittent Type which it does in many cases,
Gastritis
Sufficient has been said on this disease
under the head of yellow Fever, which is often
a true Gastritis.
Pleurisy & Pneumonia
Pleurisy & Peripneumonia arise from the same 
cause and require the same [cause] plan of cure
Peripneumonia a Fever of an inflammatory [K]
pain in the Thorax, Cough, expectoration often of
Blood, often a structure of the Thorax, pulse
rather soft, when both lobes of the Lungs are affected
the symptoms are more violent.
Peripneumonia Nocha has less violent symptoms
Pleurisy has acute pain in the side, cough,
pain often short up to the clavicle, difficulty
of Breathing from the pain, pulse usually hard &
quick, more frequently seated in the right side.
A spurious pleurisy is distinguished by a soreness
redness of the part
It is a Rheumatism

122
Fever is not always a Synocha, in situations
where intermittents are frequent it is of that Kind
A resolution of the Disease is alternated with
expectoration, urine thick, sweating profuse,
Bleedings from nose, uterus, by Diarrhaea, an
Erysipelas, by abscesses, Not unfrequently it changes
to the Abdominal Viscera & to the Head & Throat.
The signs of suppuration are ceasing of pain,
slight shivering, Hectic Fever, dry cough, lying on
the affected side, cough & difficulty of breathing
often continue. This forms a Vomica & which
may burst & instantly suffocate, When it breaks
into the Thorax it forms the Empyema. It may
get into the Abdomen, it may press on the
Diaphragm & be mistaken for Hepatitis. The
symptoms of Empyema are not very certain
Peripneumonia may terminate by effusion into
the Lungs with a Liver like appearance. It sometimes
terminates in effusion of Serum forming Hydrothorax.
Gangrene sometimes terminates it. Schirrous Turbercles
& adhesions to the Lungs may end it. The
adhesion is a common

123
Predispary Causes, labourous life, unsound
lungs, bad conformation of the Chest, Rheumatic
affections, Winter & Spring. The life from puberty
to old age.
Occasional Causes such as produce other
Cold applied to the Hot body, sudden changes of
weather, external violence, great exertions in
speaking, Epidemic causes, miasma. Hard drinking
violent passions, whatever produces plethora. Is it ever
contagious? I cannot determine this point. The
common acute Pneumonia is certainly not. The
Typhus is said by some
Morbia [app????ius], Inflammation, suppuration
effusions. Gangrene, Lubices, adhesions, the
Lungs of a fleshy appearance, Heart sometimes
enlarged,
The mode of treatment in both affections are the
same. The distinction in [practica?] is useless,
Prognosis, a violent pyrexia, stubborn not
much yielding to the remedies, that produced by
marsh miasas water, Great cough, a dry Cough,
are bad, its acute pain denotes a violent

124
can but less dangerous than obtuse pain, a
changing from one side to the other, delirium,
are bad symptoms.
Cure. The indications are the same as in other
phlegmasic inflammation. The Antiphlogistic plan
or the tonic plan may be required according to symptoms.
The best of remedies is the Bleeding, as soon as it
appears Blood must be taken, if it is violent
it must be repeated & pretty largely. The symptom
must dictate the use of the Lancet. An early use
of Blisters in my hands has prevented the necessity
of profuse bleeding. It is the opinion of some that
VS,, should be continued as long as the Blood
throws up the inflammatory crust, but this
sign is equivocal. It is necessary that the first
Bleeding should be large & drawn from a larger
orifice, & may be proper to lay the patient in
a horizontal posture & bleed till he faints
Cathartics are important, it is necessary to
keep open the Bowels, under some circumstances
I have used powerful ones with advantage.
Blisters are to be applied but not until after

125
on Bleeding at least. If it evacuates well &
is attended to another. Bleeding will often not be
required but this is not always the case. They
should be applied as near to the affected part
as possible & I find them useful even on the
arms. and particularly in the latter part of the
disease. I have never kept one or two days
12 hours is a sufficient length of time.
Sinapisms have been recommended & I think they
cannot be safely used, as they are not evacuents.
In cases with Typhus may be useful. I have
employed Digitalis after evacuations with advantage
when the pulse continues quick & hard I use it
with Nitre so as to excite a little nausea, it will
be particularly useful if there are any effusions
Expectorans are necessary after VS,, Small doses
of Ipecac. with or without Creta usually with a
little Calomel, Blue Pill, Hermes Mineral, Squill
in different preparations, Senega in the active
stage of the disease will increase the violence
of the action & make the Blood assume the
inflammatory crust, it is not adapted to [gener??]

126
Pleurisy, on account of its highly stimulating properties
Inhaling steam of warm water impregnated with
vinegar is useful. Emitics have been sometimes
used but have been rejected by other physicians
doubtless their exhibition in the active state would
be injurious but in the Typhoid Pneumonia
an early exhibition of them is essentially necessary
& the last Kind of treatment. In that kind called
Billious and has some connection with
Intermittents Emetics are necessary. After the
inflammation has been reduced by VS,, Opiates
are useful but it must be observed not to use
them until after evacuations. A repetition of VS,,
is usually necessary and Opium will increase
the inflammation if it is not sufficiently subdued
A slight salivation has been useful after repeated
VS,, have failed to remove all the symptoms.
small doses of Calomel are indispensible after a
bursting of a vomica. I always use it with a
little Ipecac. The diet requires much attention
where VS is necessary mild vegetable diet must be
used, milk is improper, Runnet whey is proper

127
All other animal food must be withheld
Drink of Mild diluent Kinds, the Bed Clothes
should be light & he Kept up as much as
possible to avoid heat. The temperature of the
room must be regarded. This finishes the cure of
acute pneumonia.
Much has been said respecting the use of the
Bark in Pneumonia. In the acute no one would
use it, The Phlegmonia is often combined with
a fever different from the Phlegmasia, The Chill
is of long duration & continues longer. It requires
VS,, but not large; after this Bark is necessary to
perform a cure. The Bark has been useful in the
Typhoid Phlegmonia. where Bleeding was fatal.
the [crossed out] [illegible] was very useful in it. This prevailed [illegible] [illegible]
in several parts of Pennsylvania & New Jersy. The 
Senega was also used. Camphor is useful in this
disease, In substance in 4, 5, or 6 Gr with Opium
often repeated was useful, promoting [expectoration]
Carditis
Probably cannot be distinguished from other Inflammation
of the Thoracic viscera, The treatment is the same

128
Cynanche.
Is a generic name, is a [illegible]. Fever not always
inflammatory, pain & redness of the Fauces, these
are the generic Symptoms
Cynanche Tonsillaris
Is an inflammation of the mucous membrane of the
Fauces, is not contagious, yields to Antiphlogistic
remedies, Astringent Gargles are necessary to a cure.
A decoction of Oak Bark & Allum is the best.
It is apt to return often when once it has attacked
particularly in Cold & changable, the Cynanche
Pharyngia is of the same nature, only seated
in the Pharynx.
Cynanche Parotidia
Cullen defines it, Is attended with a tumour
of the Parotid Gland, Fever inflammatory &
little difficulty of Breathing & Swallowing. He should
have mentioned the swelling of Testicle or Breasts,
The swallowing is sometimes interrupted & the
Fever many times Typhoid. A lassitude, [hia??ss]
Several days before Swelling comes on, rigour
stiffness in the articulation of the Lower Jaw
a swelling then attack the Parotida & the

129
neighbouring parts, it daily swells, the tumour
increases, deglutition is frequently interrupted, Fever
often great, and here the disease usually ends,
About the 4th day a sweat comes on about the Ears
which extends over the whole body. & the disease
goes off. If the Swelling goes of suddenly about
the 4 day the Testicle is apt to become swelled,
which must be treated as in the first stage.
The Breasts are often affected in Females, & also
their Inguinal Glands, probably also is the Ovaria
less frequent however than the Testicle of Males
Usually occurs as an Epidemic. It was Known
to the Ancients. That the disease is contagious
I think far from being established. I think
Mumps are not contagious but are depending
on some unknown state of the [asma???]. It
may be connected with Marsh Miasma & then
be contagious. I believe it may be concluded
it will never twice affect the same person.
Dr Hamilton avoided VS,, unless the pulse was very
Strong & Quick, Blisters should be applied even
the swelling before any discharge has commenced
Laxative Cathartics or Enemas are necessary.

130
The Typhoid cases required the Cordial treatment.
Sometimes the Testicles swell & then gradually
waste away & the patient becomes impotent.
When the Mumps attack the Brain the Testicles
should be wrapped up in a Blister.
Cynanche Trachealis.
Cullens definition is, attended with difficult
Respiration, inspiration with peculiar sound, Fever
of Synachal Kind. There is a close connection between
phlegmonia, and it, and the croup sometimes turns
into the pneumonia and vice versa. It often comes
on like a Cold or Catarrh which may continue
1, 2, or 3 days before the Croup is formed. It has
run through in 24 hours. It is knowing by a croaking
sound of the voice, like the barking of a y
Dog, Respiration more less difficult, Fever usually
of Synocha, a straightening sensation in the Chest,
a hissing noise in breathing, a peculiar
countenance, face full, eyes of staring & full,
as it goes on trembling, restleness, violent palpatations
Breathing becomes more Stredulious. Puking may
come on, though rarely but of little benefit. It
affects children at the breast but less often

131
than afterwards to the 9th year. Adults are
also affected with it, Genl Washington fell by it.
It attacks more adults in some countries than in
others. I have seen several genuine cases in
Adults. I have seen some facts that would lead
me to think there is a predisposition in the habit
to this disease. I am satisfied that it is not
contagious but it arises from the same causes
as Yellow Fever and other diseases which some
suppose are contagious. On the 3d & 4th,, day many
die with it, fewer on the second, A spurious
Croup is described by the British Physicians,
The Cough is said to be less sounding. But
after all I believe it is nothing more than a
modification of the Croup. There is more reason
to divide it into Ideopathic & Symptomatic,
The former is a Synochal affection, the other &
often a symptom of Ulcerated Sore Throat, &
originally the Trachea, it is not a Synocha, The
Ulcers extend from the Throat into the Trachea
and cause a disease difficult to distinguish
from the Ideopathic. Is a very dangerous
affection. Much has been of the Spasmodic

132
Croup. Dr Rush at one time considered all
cases as spasmodic but he lived to change
his mind. I would not positively deny that
there is no spasmodic variety but I have never
seen a case. It is true that antispasmodic
have been given with success. Much has also
been said about the Membrane that forms in
the Trachea, it does occasionally occur but
thousands of cases do exist and terminate
both fatally & favourably without the formation
of it.
Remote Cause. Cold & Moist atmospher
Marsh Miasmata, Cold itself, in many instances
must defend on a peculiar modification of
the Air independant of Cold, the contagions
that induce yellow & other Fevers. I have seen
several cases blended with yellow Fever, It
sometimes attends or succeeds Small Pox. By
Metatarsis of Pneumonia & of acute Rheumatism.
A case occured to me which was cured by
a discharge of worms by vomiting.
Predisponing Causes. Infancy &
a gross state of habit, moist atmospher

133
Catarrhal affections, measles. pneumonia. &c
Dissection. Fauces are free from appearance of
inflammation, the Glands at the root of the Tongue
are swelled, the Lungs usually nearly natural
in the Thorax, In the Trachea a quantity of
mucous or a tubular membrane, sometimes has
extended from the Larynx into the Bronchia, from
the thickness of writing paper to nearly fill up
the passage. Formerly was supposed not to be an
inflammatory disease.
Remedies. The First is bleeding, when we
see the case early it will usually yield
more easy to VS,, than to any other remedy.
This practice is now recommended by most
physicians. It has been carried to a great
length in the U.S. Dr R. took 12℥ from a child
of 4 at 4 [crossed out] Bleeding V.S is not always necessary
to cure it, I have cured many case without
It is much more inflammatory at one time
than at another. Leeches have been recommended
by some Physicians. Blisters are important
and most useful when applied over the

134
the Trachea. A Sinapisms over the Trachea
are often surprisingly efficacious and prepare
the system for other remedies. Emetics are
of great importance; In general VS., should
preceed then. Ipecac, I most employ in
powder with a dose of Calomel, Antimonials
are much used particular Tart, Emit & Vinum
Antimonium but I am not much in favour
of them. Turpeths Mineral I recommend as
a safe & good Emetic, for a child 3 years old
I give 2Gr often with a little Ipecac. Muriate
of Mercury is much used in Maryland,
Dr Archer now prefers it to Senega, He gives it
in drops till it vomits. Blue Vitriol is used
on account of its sudden operation is now
much used in the Southern States. Sulpt of Zinc
I have not found useful. I have used an
infusion of Mustard when there is little
action. A teaspoonful of recent prepared
Mustard is to be used. The Senega was
mentioned in Pneumonia, Dr Archer used
it much, I have often found it useful

135
I give it in infusion till it causes expectoration
& vomiting freely. Dr Archer probably extolled
its properties too high. A more durable stimuli
cannot be made on the Trachea by any vegetable
than by Senega. When it was considered as
spasmodic Assa Faetade was recommended
& used successfully, Is a diffusible stimuli.
[illegible] The Fecula of Indigo has lately been
used with much success. I have not used it.
The alliacious plants have similar effects to Foetada.
are more efficacious when combined with Antimonial
wine. Sanguinaria Canadensis I have used with
success is Emetic expectorant & stimulant. Might not
the Errhines be useful? Calomel is useful given
freely, is given to salivate, puke and purge, Its. salivatory
power is of no use in this disease, it will rarely
do it in so short a time as this disease, it,s
advantage is produced by its emetic & expectorant
I always give it & in large doses frequently.
I combine Ipecac with it. The French
say that in the second stage the inspiration of [illegible]
Ether is useful.

136
Very Strong Coffee is often very useful. Diaphoretics
are good, Antimonials was much used by some
physicians. Warm Bath important remedy, but
in some cases I have known it hurtful. In the
latter stages when the danger is past a little Laud,
with antimonial Wine or [?xynal] of Squills. Diet
requires to be attended to. Issues in the neck or
arm perhaps in some cases would be proper
to prevent a return of the affection.
Bronchotomy. Physicians are of different opinion
about this operation. Dr. Chyme,s objections I think
are not [of much] satisfactory. The operation has
been performed successfully in general without
success. Out of 12 cases I believe in 8 no membrane
is formed and it is very uncertain when it
would be successful. For symptomatic Croup
Bleeding is improper, Emetics are necessary, Blisters
are useful if not too much tendency to Gangrene
Bark in large doses, Vol, Alkali useful,
Foetada/ Mercury with considerable success

137
Cynanche Maligna or scarlitina Anginosa
Cullen supposes they are distinct disease but my
experience teaches me that they are the same.
Cullen difines the Cynanche Maligna is an affection
of the Tonsils & membrane of the Fauces, Swelling
ash coloured, crusts, eruptions, Fever. On the
4th day face swells and florid redness in
distinct spots appear, His definition is not
altogether correct. The Scarlitina Anginosa the
patients usually a Child, dejection, soreness
in the muscles of the Neck, Stiffness, shivering,
2d day the throat affection increases, with difficulty
of swallowing. Skin hot & dry, smaller pungent
points, breath hot & burning, thirst, uneasiness
on the 3d day morning, the face, breast appear
red which increases over the whole body like
the colour of boiled lobster, where we press the
surface colour disappears but soon return
Skin smooth without pimples which often marks
it from measles. This continues 2 or 3 days, the
colour becomes brown, & Beanlike scales
passes off. When it attacks adults large livid
spots are seen on the Elbows. When Cold

138
Pulse small weak quick, The Fauces partake of
the redness it often happens that no ulcers affect
them. It presents a more formidable form.
The Skin becomes very hot, delirium comes on.
In no disease does the heat become so high
as in this. 112° have been known. It has been
said that the delerium is not a mark of much
danger. Pulse often beats 130, it is sometimes
hard seems to require VS,,. Anasarca often
attack about 12 or 15 days. The health for
several days does recover, pulse becomes quick
and at length dropsical swellings appears &
often terminates in death.
Prognosis. It may be confounded with
Typhus Petechialis, In the last the spots are more
regular more confined to the neck & Back,
It may be also confounded with Puerpera of
Children. also with Measles. The cough, watery
eyes & running of the nose Dr Wirthing says
does not occur in Scarlitina. In Measles the
eruption arise higher on the skin. They are
often confounded together. Also with Erysepelas but
this does not usually affect so much of the

139
body, but I have seen one half of the body
affected with it. I believe there is little doubt at
present that Cynanche Maligna & Scarlitina Anginosa
are one and the same disease. Nor do I hesitate to
say that Cynanche Parotidae arises from the same
specific poisen. I cannot say whether the mumps
will prevent the system from being acted on by
the poisen of Scarlitina. It has been well
ascertained that the Ulcerous Sore Throat of
[Fochug???] was only a modification of the
Scarlitina. Dr Heberteen found that both were
alway prevalent at the same time, This [is] has been the
case in Philadelphia. In 1777 at Copenhagen three
varieties of Scarlitina was observed, one appeared
under the form of Lobster eruption, the second
with it and some swelling in the throat and
in the third it was confined entirely to the
throat. In Scarlet Fever after the Fever has
subsided the Parotid Glands often become affected
as with Mumps. The nature of the contagion
which induces all varieties of these diseases
we are entirely ignorant. Several theories have

140
have been given more very satisfactory. One that
they are owing to Animalculi but this is with
out foundation. It is undoubtedly an Indigenous
disease, we find it described by the earliest
settlers in the Southern section of the Union.
When we see a lobster like eruption with a sore
throat along the course of a Fever we [are] to
suppose it causes [illegible] from the [River] or
something connected with it.
It is undoubtedly contagious, when it [alighten]
in the fauces a particular taste will long
remain which gargles of water, acid &c [illegible]
[illegible] remains, it tastes like Sulphate of Iron
This is the idea of the English Physicians but
I think it is incorrect. but I have been salivated
by only [illegible] patients with it.
Cure. The several Kinds as Lobster efflores [illegible],
ulcerated Throat, & when both exist.
The first requires little Medical aid, diet light,
chambers well aired, a mild laxatives, but the
least done the better, Weak Wine Whey, as a
diaphoretics.

141
The second Kind where the Throat alone is affected
Bleeding has been used in Scotland, but usually
is improper, Purgatives have not usually been
necessary, however I often give Rhie & Calomel
Dr,, Rush supposed they would render it milder
if given about the time it attacked.
Emetics are very useful, If given when it first
attacks [some physicians] think will arrest it but
this is not correct but they will make it milder,
Dr Rush gave Emetics with Calomel. All Physicians
agree as to the usefulness of Emetics in the first stage,
I have given Turpith Mineral & I prefer it to most
others. In the use of Blisters Physicians disagree
Dr Withering says that if delirium come on early
they would be injurious. In America they are
used considerable. The same regime is required
as in the other form. The inordinate heat seems
to call for application of cold and it,s use
is now established by experience. Cold water
is highly useful. Via Curries Reports. The practice
is universal in this city, The Oxy muriatic Acid
has not been used in this city. 10 or 12 Gt is the
dose for children, ℥ss for adults. Sulphuric

142
Acid has been used with advantage.
The Anasarca seems to require Diuretics & the
vegetable Fixed Alkali has been employed.
Gargles of different Kinds have been of much
service. astringent, & antisceptic ones. At the decline
of the [efflorescen?] if the Fever also declines. Bark
& Cordials should be employed. I am confined
to think that in the worst cases the Carb, Ammonia
might be used with much advantage,
Exanthemata I shall now consider, is the
3d,, Genera of Cullens. All the diseases which I shall
place under this head are contagious.
Morbilli or Measles.
Dr,, Cullen defines it: A contagious inflammatory
disease with sneezing, with a dry cough. on the
4 day these break out small spots which go off
in 3 days in scaly disquamation, Often affect
children. There seems to a predisposition to it,
but I think no one is exempt to it, whether it
will affect the child in Utero. the Small Pox
will do it. A child in Utero may require it though
the mother has had it before. I think it is taken
into the circulation & not by the vagina

143
Is not apt to induce abortion in pregnant
women but Small Pox will very often do it.
Is a specific disease. It may appear at any season.
I believe I have seen it every month in the year.
Most frequent in Jany. Feb. & March, They begin with a
cold stage not usually of a severe kind, then
ensues the hot, which is attended with sickness
nausea and debility, the pulse quick. The Fever
grows more violent till the eruption breaks out
which about the 3d or 4th,, day, often on the 2d,,. & it is
sometimes delayed even beyond a week, in one instance
it was delayed to the 16th,, From the commencement
their is a hoarsness, cough, often difficult respiration
often the eyelids are swelled, the eyes more or less
inflamed, a discharge from the nose, sneezing
a drowsiness more or less profound, a coma from
the first is usually fatal. The eruptions begin
on the forehead, then on the arms & then extend
over the body. The spots seem to arise a little
above the surface, but it requires to be distinguished
by the touched. On the face it retains its redness
a change after a time a Bran like disquamation

144
ensues with itchings, first begins on the face.
The eruptions are liable to great irregularity.
The fever sometimes goes off without any eruptions.
The fever somtimes ceases as soon as they appear
but it usually continues till the bran like disquamation
begins, & sometimes longer. The cough is
apt to continue longer than the fever & often
a Pneumonic affection ensues. A Phthis Pulmonaris,
a weakness & inflammation of the eyes, particularly
if the habit is scrophuluus, is apt to succeed
the Measles. They apt to predispon children
to Cholera Infantum & Adults to Dyesentaries.
When Measles are Epidemic we see many cases
that are very mild & without many of them
disagreeable symptoms. There is such a disease without
Catarrh which does not prevent the system from
being attacked by a violent case of measles.
We are informed that they are [illegible] with the
Small Pox but it is now believed that it is an rumor
of Erysepelas and Small Pox. Dr Darwin says
"That two contagious diseases will not both act
in the system at the same time" We frequently

145
Syphilis & Scrophula existing in the same system
at the same time, We are ignorant of the nature
of the poisen which produces measles. This disease
was unknown in America before 1492 - We are
sure they depend on a Specific Contagion, Like
Scarlatina & Small Pox they affect the same person
but once. There are 3 distinct stages as in all
Exanthema. First from the Fever to the eruption.
Second takes in the whole period of efflorescing.
Third is the declination or the disquamation.
A Mild Diarrhea, considerable discharge of Urine
A Moist skin, Epistaxis, after the eruption is full
a spontaneous vomiting, Expectorati are favourable
A Peripneumonia particular if a violent Diarrhea
wasting sweating, violent pains & lassitude before
the eruption, a sudden disappearance of the
eruptions, with delerium are unfavourable.
Treatment Venesection the most important
Blood may be drawn at any time attending to
circumstance, particular in first stage in habits
that are weak & predisposed to Phthis. a hard
pulse, pain under the sternum, Cough, inflamm

146
of the eyes requires VS,, which often requires to be
repeated. Usually the more violent symptoms do 
not appear till after the eruption comes on.
Bleeding then will be necessary attending to the
circumstances & repeat as often requires. VS,, prevents
hemmorhages and brings on the efflorescence. This
is important. The Cough requires attention. The
expectorants are less important that usually considered
Dr Cullen used opiates to alleviate the cough,
except when there was much inflammation, They
may be used after these symptoms are reduced.
It must be used temperately, I have used the
Brown Mixture. Common Mullin Tea will also
allay the cough, The blows of the Bass wood
are very useful made in a Tea [are excellent].
Blisters are next in use to VS,, _ they will be
proper on the chest. I have no doubt but many
cases may be well treated without VS,, and with
Blisters. There may be cases in which Digitalis
would be useful. Purges were much used by
old Physicians but active ones are hurtful
unless the inflammation is great, Mild laxatives

147
will be proper. The use of Cold air & water
generally I have prejudice against. There may be
cases where they would be useful. A medium
temperature is usually to be used. Dr Currie used a
cold effusion of Water by mistake, the cases after were
mild. I should avoid the use of Cold effusion
A peculiar hoarsness often remains after the measles
It is to be considered as a chronic disease.
Bark, Bark & Opium, and particularly Carb,
of Ammonia are useful, also Blisters.
Dissections. The Lungs are found diseased
adhesions, spots of Gangrene. We have a Measles
without eruptions, it is a Morbillous Fever. Dr Rush
called it internal measles. The system is still liable
to be affected by the true measles.
Innoculation for measles is now principally laid
aside. The disease begins in 6 days after the operation.
Small _ Pox. Variola.
Cullen defines it, A contagious Fever, vomiting,
On the 3d days begins a phlegmonic eruptions which
ends on the 5th & on the 8th goes off in scales often
leaving small pits. He has two species which are
only varieties. The Distinct & Confluent.

148
The pustules come out about the 3d day of the Fever
which continue to increase several days.
A shivering, in the [evi???], pain in the back, nausea
vomiting, and other symptoms of Fever mark its
commencement. It may be Synocha or Typhus.
In cases of Innoculation it appears much earlier
than when it is contracted naturally, about 8
days later, The first appears on the 8th,, the later
the 11th,, day. Do the Blacks take it 1 or 2 days
earlier than whites? The pustles gradually increase
in size. In the distinct the Fever subsides as soon
as the eruptions appears, with confluent this is not
the case. Abscesses often appear at the close of this
disease. It often removes old Chronic affections.
I know not that it secures us from any other
complaint but it does against itself. It will
suspend many other diseases for the time. It
is also suspended by other causes. Too often it
impairs the constitute, in systems predisposed to
Phthisis Pulmonalis it will hasten the disease _
Also in Scropula.
Prognosis Pustles destruct on the fever
Light Epileptic fitts but too me not favourable

full pustles, childhood, Spring, are favourable
A Severe Synocha requiring several VS,,, fixed pain
in any part of the body; a Typhoid Fever, an
early eruption, pustles filled with a watery &
bloody fluid, an unusual determinate of Blood
to the Head or Chest, Petechia, Hematuria,(Never
recover from) a premature subsiding of the
pustles, difficulty of Breathing, abortion in
Females are bad, Pregnant women are apt
to miscarry [or] the









Pthisis Pulmonalis.
Cullen defines it thus, emaciation, debility, cough
Hectic and usually expectoration of Puss. He divided
it into the Incipient which there is no
expectoration of puss and the Confirmed in which
it has commenced. He has many species which
he names according to the remote cause, as
Hemoptia, Pneumonia, Asthmatica, Calculosa
Exanthemata, Febrica, Arthritica, Chlorotica, Scrophalaria,
Scorbutica &c,,-. Our subject is the consideration
of the True Pulmonary Consumption. The Hectic usually
attends puss in the Lungs, there is always more a less
Hectic when puss is in the Lungs. It is many times
difficult to determine whether an ulceration is in
the Lungs or not. At first the symptoms vary according
to the remote cause. When it comes on gradually
a dry cough, dispnoea, straigtness felt in the chest,
redness of the tongue, pupil dilated, cheeks flushed,
temper irritable, albugenia white, are to be observed.
All these symptoms may attended other disease.
The dilitation of the pupil is always present from
the commencement. These symptoms increase, the

pulse becomes quicker, Fever increases at night,
night sweats, spittings become copious, taste often
vitiated, expectoration resembles mucous & blood, We
have no positive criterion to determine puss from
mucous, See Cullen, & Charles Darwin,s - observations.
Often the patient can rest only on one side.
Sometimes a slight pain in the side often now in any
part of the Chest. Blood has a buffy Coat, even to
the last hour of life. Strength declines, body becomes
emaciated, the mind full of hope and a fine flow
of spirits, The Fever continues but a little time before
sweats appear at every exacerbation. Urine becomes
high coloured and deposits a sediment, Appetite good
often unnaturally voracious. Thirst not often great.
Mouth usually moist, sometimes dry, Tongue is usually
without fir, sometimes the Fauces & it are covered with
an aptha in the last stage. Cheeks pale with a
circumscribed red spot on them. Early, costiveness, later
an obstinate Diarrhoea which often alternates with the
sweating. In the last stages dropsical swellings often
occur. Delerium is rare. Hectic is the consequence
of absorption of puss from the Lungs, The most common

causes of ulceration in the Lungs are Hemoptysis
Pneumonia, Asthma, Catarrh & Tubercles.
Hemoptysis. may often occur without inducing an
ulceration. it occur occasionally for years if the
system is not predisposed to Consumption.
Pneumonia often terminates in a suppuration of the
Pleura, and forms a vomica. Hectic ensues.
It may continue a considerable time without
bursting, when it becomes effused into the chest it is
called Emphysema. The vomica are somtimes absorbed
and a cure ensues; it sometimes is effused into
the lungs and brought up by vomiting. We are
never to look for a recovery particularly in those
predisposed to consumption though a cure may
perhaps happen in 5 cases in 100.
Catarrh particularly that termed Influenza is
a very frequent cause of Consumption in this
Country. That of measles most frequent.
Asthma is a less frequent cause, though the
spasmodic Kind may end in suppuration.
Tuburcles Dr Cullen supposed to be the most
frequent, They are small furrows resembling the
indurated glands. At length a suppuration like

the Scropulous kind ensues & finally ends in
Consumption + I am inclined to believe they are
inorganic substances. Dr Rush considered them as
an effect and not the cause of the diseases-
Consumption may arise from an inflammation of the Liver
The connection between the Lungs & Liver is very
considerable. Splentis may also lay a foundation
for consumption. There is no reason to doubt that
climate sometimes resolves Tuburcles. Syphilis is
a cause, when long continued will induce
consumption. I suppose suppressed Gonnorrhoea
may produce it. The Phthisis from Lead I am
unacquainted with, that from calculi in the
Lungs not very uncommon what the source of
the calculous matter, is unknown. In one case
it was lodged in the Lungs and taken from the
bones. Persons exposed to dust are liable to the
Phthisis, such as Millers, Stonecutters &c. In young men
the Venus Solitaria is very often the cause in them
who are not even predisposed to it _ Also in the
other Sex _ a [Tab?s] ensues which ends in a complete
consumption of the Lungs. Pertussis is a very
frequent cause - in all ages of life.

Intermittents are a frequent cause, I have seen many
cases commencing with all phenomena of this
Fever. Some have considered Phthis Pulmonalis
as contagious. Perhaps it occasionally may be
some circumstance would leed us to think [they]
it may sometime be but it is not common, I am
inclined to think there is little foundation for
the conclusion that it is infection
Predisponent Causes. predisposition, a
scrophulous disposition, there is a great connection
between them, there certainly is a great affinity
between them. Peculiar conformation, narrow chest,
weak habits, great sensibility, disposition to
hemmorrhagies. The age is from Puberty to 35th year.,
is the most common for it to occur. D Rush
supposed it to arise from Civilization, This is
incorrect. Scrophula & Phthis are common in
the tribes of Savages. Is more rare in very Cold
climates and in the Hot climates, Very common
in Great Britian & the U.S. particularly in the New
England. Probably as many die with Phithis
in New England as of malignant Fevers in the
Southern States.

Consumption. from Hemoptysis is more oft cured
than from Tuburcles. Hemoptysis is not always
followed by consumption. A Mania has removed
the disease- Pregnancy suspends it, though it
will return after delivery.
Cure & Prevention. The cure seldom is performed.
Dr Cullen says it was never cured by him. I am
loth to consider it as incurable, but if any
disease is, it is this. No one kind of medicine is
to cure it, very opposite remedies are to employed.
It is hereditary. Our first attention should be
directed to keep it off in those predisposed
to it, in Measles Catarrh &c,, In Hemoptysis [illegible]
occurring without an evident [ca?n] is to be
attended to it. our precaution is to be continued
for several years. In Pneumonia Inflammation
in those predisposed our greatest exertions must
be applied to procure a solution. In Catarrh
every attempt should be adopted to get rid
of it. Asthma is a frequent remote cause & when
it attacks those predisposed every means
should be used to keep it off. The Carbonate
of Iron. is very useful to do it.

I believe Tuburcles may somtimes be resolved,
I am not sure ever has. In the Scropulous Kind
Sea Water has been popular but I believe it is
ineffectual. Though I am fully convinced the
is the greatest analogy between Phthisis &
Scrophula yet an opposite mode of treatment is
very often to be pursued.
Mercury. has been much used for Tuburcles.
The use is at least 200 years old. Dr Chyme used
it for Consumption 70 years since. Dr Rush seemed
to consider it as being introduced into practice
by him but others used it before. him, I have
little to say in favour of its use, I have
used it in all stages but never with complete
success. It sometimes seems to arrest the first
stages. Calomel & Blue Pill are employed.
Other plans have been more beneficial than the
Mercurial. Such as that of vitriolic Solution,
of Ipecac &c,, No sooner does the effects of Mercury
go off than the consumption immediately returns,
I have effected nothing good by it that milde
remedies would not have done. It is often

difficult to excite a Salivation. Some Physicians
recommended higher than I do, In some affections
related to Phthis Pulmonalis it has been useful.
In Europe it has lately been used in the confined
cases but it has failed. Dr Currie used it in
combinated with Digitalis it then seemed to
afford some relief but performed no cure.
The Arsenic has not been much used in the
first stage to resolve the Tuburcles ; but I have
used in this stage with success in several cures
For preventing the Inflammation of Tuburcles small 
Bleedings repeated frequent are necessary.
The Diet must be light and low. An abstinence
of all animal food with the exception of Milk.
The farinacious vegetables, Milk, are proper. I
believe one kind of milk may be better than
another, The Species of Animals, the healthiness;
& the food will alter the properties of the milk,
but I do not believe that Asses milk is so
much superior to any other Kind. It is prejudice
that has recommended it so highly, I do not
think it proper for a large portion of the diet
it is too nourishing & Stimulant in many

cases. In Great Britain & Ireland consumption
& Scropula are very common though milk is
the most common food. The prepartion of milk
are proper such as Rennet Whey.
Bleeding is proper. It is objected too by the
practitions in England. It is to be repeated.
Leeches & cupping are faster used. Large Bleed
does no good. Digatilis has been used to
reduce the circulation, It was at first thought
by some to be a specific. is now believed to be
by no one. Seldom have I found it to be
of much advantage. Its use requires much
attention. It may often be a good auxiliary to
the Lancet & it sometimes subdues the cough
When Phthisis is complicated with Dropsical
effusions particularly in the Thorax & when
there is a bursted vomica it may be of
use. For taking of the inflammatory determination
from the Lungs Blisters are proper
As long as bleeding is useful they operate
as evacuants. They should if convenient
be laid on the Thorax, if not on the arm
above the Elbow. The Stimulants applied

as Unguent Savina after the Blister is hurtful
in this complaint. I am much in favour of
Blisters. They will moderate the complaint
as long as they continue to discharge. They
often succeed better than VS,, - If it is ever
cured in the Confirmed stages I believe that
Blisters will be one of the Remedies.
The Setons are also useful _
Emetics. What their operation is I am uncertain.
Different emetics have been used, but not
in the Typhoid stage. Antimonials are
improper. Sulphate of Copper is a good one,
The Vitriolic Solution has been strongly
recommended in it. Dr Mosely says it is
useful in all cases of pulmonary affects.
I have used it in a tablespoonful [illegible]
a day to nauseate. Is an important remedy
Ipecac I am most attached to combined
with chalk, particularly [illegible] then is Hemoptys.
The Tonic plan has lately been recommended
in Europe in all stages. They give Emetics every
2d day & in the internals Bark & Opium

Arsenic is an important remedy but not a
specific. Is adapted to prevent violent
paroxysm of Hectic ushered in with a Chill
It has great power of the Hectic. It will
arrest it for months. It will controul the
disease surprisingly.
Acetate of Lead I have used in all stages
when Hemoptysis is present, but further than
this I have not gone. When Hemoptysis is
present Mercury will increase it. I have
known a bleeding from the intestine brought on
by it. In one case it has been useful when
a vomica has burst with little fever small
doses of Calomel.
Bark I have nothing to say in favour of.
In the first stages it is improper unless it is
combined with catarrh & Intermittents. It
produces a tightness in the Chest. Where the
Hemoptysis returns [p??????d] it may be
useful. In ulceration of the Lungs with a
Hectic of an intermittent Type Bark given
in the apyrexia it has done good.

When extensive ulceration exists with some
Hemaptysis Bark & Elix vit. will often do
good. Balsams have been recommended
but they will prevent the heating of the
Ulcers. The action already is to high for the
to heal. Myrrh has been recommended, I have not
used. Bal Tolou has done good also the
Tar Water. The Inhalation of Ether has been
recommended, I have not used it. The fumes
of Resin & Wax have also been respirated. but
in two cases it increased the complaints,
The air of Cow Houses have been recommended
but I have nothing to day in the favor of
so brutal a practice.
The Cough requires attention, it increases with
the disease. To allay this opiates much be used
I prefer the Brown Mixture. In the early stage
require some caution; in the latter freely.
The Gum Opium is next useful to the above.
The Ext of Hyoscyamus is often efficasious, even
as good as Opium or better in some cases.
The sweating is to be palliated by Elix Vit,

Lime Water & Uva ursi. The Diarrhoea
will run down the patient, must be treated
with the Cretaceous Julep, Kino, Acetate of
Lead, & Opium. Dr Cullen says that Rhei &
other cathartic are of no use. In the latter
stages, Bark, Vol alkali, Camphor. are to be
used. Gestation - riding on horseback is
adapted to the earlier stages if not too
inflammatory. See Sydenham & Rush on it.
Riding in a carriage may be continued till
near the close of life. Swinging I believe is
of little consequence. The most important is
sailing. What effect this has is uncertain.
Nothing is better to keep off Phthisis in those
predisposed than a change of climate. Go
from that climate which caused it. The
Northern people can fly to the Southern States
& Bermuda. The [Alco?nag??] has acquired
great reputation but I believe undeservedly
Very little effect is produced by it. The
introduction of it was first a mercantile
trick.

Scrophula.
Is so nearly connected with Phthisis that I have
placed it next to it.
Cullen defines it. Tumours of the Conglobate Glands
Florid face, tumid Abdomen & swelling of the
upper lip. He makes 4 kinds 1st,, The Simple or
Common. 2d The Mesenteric - simple internal. This
is the Mesenteric Fever. 3d,, The Fugacious or [Frannt?y]
scrophula affecting the neck from affects of
the Head. 4 The Americana, of this I know
nothing. A thickness of the upper lip is said to
mark the Scrophulous habit. It does usually swell
in scrophulous habit. It usually appears in
early age, but there are exceptions to this. Even
after 30th year it has occurred. Is a disease of
the general Constitute. It affects different parts.
The Ophthalmia is often scrophulous. It is the
opinion of some that the disease of the Head,
Hip Bone, & White Swellings are scrophulous.
The Abdominal viscera are also often attaked
by it. It is supposed to be owing to an
inactivity of the absorbents. It is more then

probable that the white Swelling is owing to this
alone. The Heart & Arteries are not natural
in this action. A [want??] of Bony Matter
& the curdy matter of the ulcers show that
there action is weak & languid.
It has combined with Syphilis & when it does
happen it is very obstinate. The Scrophula
is very common in England, Is most 
frequent in the New England states. The
Indians have a great deal of it. The Blacks
are still more affected with it in the U.S.
I believe it is more common in the country.
It is not contagious.
Cure. The remedies are Tonics. The Bark is
at the first of them Is best adapted to the
external Scropula both internally & externally
Gentian, [Columbo] & the Common [alder] is useful
it is the Betula - the last is [the] often useful.
Carb. of Iron has often done good, Also
[Sulphuric] & Muriate acid are good. The
Muriate of lime has often done good & has
also often failed. Dr Beddons recommended it.

Proff. Thomson supposes it is prejudical.
Cicuta has been popular & I believe it has
often done good. Stramonium is similar.
Has been externally applied, Some recommend
Salivation but it does injury if much
is produced. If Syphylis is present Mercury must
be used. Sea Water is recommended, both
in a Bath & for drink. Frictions are useful
in swellings of the neck, must be long used.
& have done more good than any thing
else. Blisters often fail but many times
have done good, must be repeated.
Topical Bleeding usually afford but a little
relief. The Cold Bath is the most important
of any other remedy. Is recommended by all
practitioners. In Sea Water is best, The constitn
must have vigor to support the shock.
Dr Hamilton recommends Bark & Cold
Bathing: The sea air & bathing I believe is too
highly recommend. The Warm Bath is also
often useful. Purges neutral Salts repeated.
Large dose of calomel & Jalap are often useful
The general method of opium the [illegible] is by

The best application to Scrophulous Ulcers is an
ointment of verdigrese. also the Tar ointment.
The diet should be a medium one between [h]
high & low. It has been asserted that Sugar is
hurtful. The Muriate of Barytes was introduced
into practice 25 years since. I am convinced it
is a useful remedy & deserves attention. It has
lately been communicated to me that vaccine
has cure the Scrophula.
Bronchocele.
From its connection with Scropula it should
be placed near it. The use of the Thyroid Gland
is not determined. It appears at different periods
of life, Children have been born with it but it
usually shows itself about the age of Puberty.
It is spoken of by the oldest writirs. Is very
common in certain parts of Europe. Was
scarcely known prior to 1797 in the U.S. It is
sometimes discovered only by a thick Neck, at
others the Gland itself is plainly discerned to
be swollen. On the Atlantic side of the U.S.
it is rarely seen, is confined mostly to the
western country. Is seen on the Mowhawk

in Canada, Detroit, & Sandusky, in Ohio, &
Vermont. In South America is very common. It is
also found in other Animals as the Goats & Sheep.
The Cause we are at a loss about. Has been
supposed to be owing to a Calcarious matter [mixing]
with the water but this is not the cause. [in]
[Switzerland] It prevails where there is little
or no Carb. of Lime. It is not met with in many
extensive parts of the U.S. where LimeStone prevails.
It has been ascribed to the use of Snow Water.
This was plausable but it will not answer.
In Lapland when no drink but Snow Water is
used & this disease never is found there. In
the Island of Sumatria it is very common &
no Snow is every found there. It is becoming more
common in this country. The Bronchocele is induced
occasionally very suddenly during partruition. It
is found that the Thyroid Gland can be inflated
from the Larynx. I believe the Bronchocele is
produced by some modification of Marsh Miasmata.
what this is I am unable to say. It is found in
moist situation. It many times comes on like a

Intermittent. Hitherto I have considered it as a
local affection; but it ultimately is apt to terminate
in some maniacal affection. It is not as apt to do
it in this country as in Europe, but perhaps in
time it will be followed by fatuity. In the Sandusky
settlements of Savages which are old it very often
terminates in Mania.
Cure & Prevention. It is often possible to perform
both. Persons who are affected with it are often
cured by removing to healthy situation. The cure
when it is completely evolved is more difficult.
Burned Sponge. Campoharted Liniment has cured
it. Mercury & Blisters, are recommended. I have
been informed that Arsenic has cured it at
Onondago. As in Scrophula an attack of a
Fever has performed a cure. I knew one case
at New Orleans cured by a Yellow Fever. It is
indispensible to remove to some other Situation
Rachitis
This has considerable connection with Scrophula
Cullen defines it the Head large, knees swelled
Abdomen Tumid, & emaciation

The Spine is often deformed, the countenance is
sensible, mind acute, before Puberty, the forehead
is protuberent. It usually shows itself about the
time of dentition. It seems to be hereditary. The muscles
are lax & skin white, face full & often florid.
The legs are weak & bend, Nodes form on some of
the bones. The first dentition is slow. The body
wastes. the abdomen becomes tumid. Respiration
often difficult, with cough & Hemoptysis. The
bones are soft, the ends puffed up, others wasted.
Hydrothorax follows, the Mesenteric Glands are
always diseased. It is more common in modern
days. It appeared in England with the introduction
of manufacturies. also in Ireland. We shall
find it increasing in this country as the manufacturies
increase. It gave rise to the general use of boots
in London to cover the deformity of crooked Legs.
It is one of the artificial affection of mankind.
I infer it from the Savages being never troubled
with it. Some suppose it is founded in a
syphilitic diathesis; but it is supposed by some to have
existed in Europe before Syphilis was known.

It has also been supposed by some never to be an
Ideopathic disease. I have seen some facts
that lead me to believe that is connected with
Scropula but I believe it may arise from other
causes. It is often combined with it. Scrophula
is found among the Savages the Rachitis is not.
Dr Cullen supposed long nursing induced it, I am
persuaded his opinion was incorrect, Long
nursing is common among the Savages, 2 1/2 year
& 3 years [have] the children are suckled.
Castration will produce a species of Rachitis.
In Italy it is performed at the 6th year, to improve
the voice of Singers. At the age of puberty they
often attacked with [puberty] Rachitis. The Deer will
not have horns if they are castrated before
they appear. An unsual quantity of water is found
in the ventricles of the Brain.
Cure. It may be arrested when it first appears
Tonics are important such as those mentioned
in Scrophula. The Cold Bath is much used. Dr
Cullen considered it as the most powerful remedy.
Others have had much success in its use.

The reason Swimming has been mentioned as
useful, probably is. Frictions are of utility;
Exercise & Gestation. Cort Perer is of use, if the
patient can take it. Others Tonic vegetables are
mentioned as Madder, the Willows &c. The
former I consider as inert in this complaint.
The latter is more useful, Dr Heller made
his patient bathe in the decoction of Willow
Bark. The other Tonic vegetables are useful.
The Ferns are used in Europe but I have little
faith in them. The fossil Tonics as Iron, Copper
& Nitrate of Copper are often useful, The
Phosphate of Lime has been recommended, it
was probably introduced into practice from a
theoretical idea; it has however been said
by some that it has been found by experiment
to hasten the ossification of the Bones of the
young animals. It has been said by the same
physicians to be a successful remedy in
Rachitis. An Alkaline solution was applied
to the part affected externally. Of late we
have heard little of this plan of treatment

From the experiment it has been found these
calcarious substance are nutritive.
Blisters are probably useful. Setons & Issues
also are useful. Conium Maculatum has
been used. Mercurials when connected
with Syphilis is useful. Cathartic & Diuretic
have also been said to be useful. The
disposition for Rachitis favours the Small Pox
& makes it mild.
The Softness of the Bones are occasionally found
in Europe - at the same time the Phosphate
of Lime is passed off in the Urine. There
is Considerable action in the Bones in [these]
complaints. The are probably a Febrile disease.
Dysentaria
The proper place for it was immediately after
the Fevers & Exanthema. The Fevers & [Dycente??]
have all one common cause
Cullen defines it, Contagious Fever, Frequent
stools mucous or bloody, natural Feces
retained, with Tenesmus. The first appearance
as various. it may attack like a common
Fever, at other times the local symptom

attack first. sometimes a Diarrhea, a Tenesmus
ensues - stools become frequent, griping severe
loss of appetite, nausea & vomiting sometimes of
Bile, with more or less Pyrexia. The Fever
is generally a Tertian Intermittent or Remittent.
sometimes is a Synocha, sometimes is a Typhus.
The Febrile action attends for a longer or shorter
period. The Matter evacuated is sometimes
a mere mucous without any Blood, in most
cases it is tinged with Blood varing quantities
sometimes profuse, sometimes it is a Billious
matter particularly in the East Indies & the
common Dysenteri is never seen there. [Sometimes]
The odour of the feces is disagreeable, or
membranous matter, or fully substance sometimes
appear. The feces appear in the form of scybala
The seem to be formed in the Colon & when
discharged give a temporary relief.
It may run its course in 2 or 3 days or it
continues as many weeks - When it is a Synocha
if not properly treated it terminates very
soon. Nature sometimes performs a cure,
It is sometimes converted into a Diarrhea

Rheumatism & other diseases. When any thing
is swallowed an immediate inclination for
the Stool will ensue.
The Causes have been mentioned under
the Fever. The modification of Marsh &
Kino Miasma, Cold, One part of a family
will often be affected with Dysenter, the
other with some Fever, Via Sydenham.
They occur at the same time and are blended
in some persons - _ The causes of Typhus & yellow
Fever many times [?a??ed] it, I have seen
all them running together. Via. Prenyle.
Is Dysentaria Contagious? I am doubtful that it
is. Dr Cullen supposed it was: I know a [illegible]
Dysenterie has very often arisen from the
application of cold & not from any specific
contagion. Sir J. Pringle considers it as infectious
Physicinas are much divided on this point.
Dr Hunter says that it did not appear to be
contagious in the Hospitals in Jamaica. Dr
Moselys declares it is not contagious. Formerly
I considered it as contagion but later [obs????]
has led me to think it is not contagious'

but it may be propugated from the stools of the
Lacent & also when blended with Typhus but
is not contagious like the Small Pox - Measles - &c,
I believe it has no other [illegible] causes than those
of Fevers.
Proximate Cause. Cullen considers it as a 
preternatural constriction of the Colon. Others
as an inflammation of the mucous membrane
of the intestines. Others think it is a local
affection like catarrh & Gonnorhea I believe
it is often local nature _ but this is
not the general case. Animalculi has been
also considered as the proximate cause _
others a putrid ferment. That Animalculi have
been seen there is no doubt but they are not
essential. A checking of the perspiration & [delet???]
of it to the Intestines have been considered as
the immediate cause.
Dissection show much affection of the Liver
& Spleen particularly of the former. Abscess are
occasionally found on it, sometimes they have
passed through the Diaphragm into the Lungs.
They show that it is not local in most

cases. In the East Indies the Colon is subject
to an inflammation.
Cure. The pulse must be attended to. When
the pulse is strong & full Bleeding & largely
must be resorted to & repeatedly. It is not
always necessary. & in some instances it
would be injurious to the patient. Bleeding
has been carried further in America than in
the other parts of the World. An important
part is the giving of Cathartics. The following
are most important. Ol Recin Sulphur
Glauber Salts with Tart Emetics, & Calomel.
The Ol Recini is very important 1℥ is a dose
in milk or strong coffe. Sulphur has been
used & it produces little irritation. The
Ext of Butternut I have used with much
advantage. Broker doses of Sulph. of Soda
with Tart Emet is a favourite cathartic
Calomel is useful but milder ones might
often be used instead of it. Mosely,s Vit.
Solution is useful, given to excite a Cathatis
in tablespoonfuls several times a day

In warm climates muriate of Soda dissolve
in venigar has been used.
Enema of mucilaginous nature as Starch
Emetics are often useful, particularly
when combined with Remittent or Typhus
We use them in small nauseating doses
& not in full doses. Dr,, Cleghorn used
Ipecac. Dr Pringle used Glass of Antimony.
he also gave 5 Gr of Ipecac every hour till
it operated downwards. I am much in
favour of the use of Ipecac. I have seen it
of much use where it did not operate at all
as a Cathartic. I beleive its good properties
depend on its diaphoretic powers in some
measure but I have seen it do good with
out inducing Diaphoresis. I believe it has a
specific operation. It is well adapted to
the Bloody Dysentarie & will be useful as
the disease approaches to hemmorrhagy. I
give it with Opium after cathartics.
Diaphoritics must not be neglected. (See
Moseley,s Treatise) Opium has caused much

division among Physicians. Dr Sydenham
trusted the cure mostly to Opium. He gave
small cathartics & much opium in differt
preparations. Dr Synde says that is necessary
to be used earlier in the Warm climates than
it is in the Cool, Dr Ritchen says that a
dysentarie in Germany was to be cured [Opi??]
& Opium. It did not then produce constipation
he used Calomel when he wanted to purge
Dr Cullen supposed it was highly injurious
& its use would be fatal. He saw but little
practice in this disease. Dr Heberden used
it sparingly but more freely than Cutter, He
gave it after evacuations, in Enema. The
two last physician saw none but mild
cases but none of the cases in camps & in
this country. Their practice would have been
fatal here. I have never failed to use it,
& in considerable quantities. I have known
cases cured by it alone. In using it I
always preceed it by evacuation. Oft I give
it solid & combined with Ipecac.

Blisters are proper, in mild cases should
be put on the extremities & if obstinate & much
inflammation must be put on the abdomen
Salivation is not a new remedy, formerly was
used here lightly, See Dr,, Clarke). If the
mercury does not produce good effect in a
few days it should be laid aside, if it
does not do it soon it will be hurtful if it
is continued. Its use is a nice & difficult
matter. Dysentarie is often complicated
with Scurvy. It was the case at New Orleans
when Gen Wilkinson,s army was there. When
this is the case mercury will be fatal. The
use of mercury in Dysentarie originated in the
U.S. In 1795 it prevailed here as an Epidemic and
I used it with much success; of late it has not
been as successfull, & where milder remedies
will do they should be employed. If no
sensible effect is soon produced it will do hurt.
The Nitric Acid is now sometimes used in West Indies
Though the heat is considerable cold affusions
will not be beneficial.

When complicated with an Intermittent the cure
must be varied. On the days of Intermimn
Bark is to be used & on those of the Griping &
Tenesmus the common remedies for Dysenter is
to be employed. Other remedies similar to Bark
may be used. I have been assured that a decoction
of Cornus Florida has done better than Bark _
Diet [illegible] [illegible].- When it forms a part of
Typhus or other Fevers we must watch
the original disease, it is to be treated as the
original disease. Pringle used the
Opium - other the Vol Alkalis. Whipping has been
used as a remedy [in remedy] in Dysentarie _
Diarrhoea.
Cullen defines it, Frequent evacuatins by Stool,
not contagious, no primary Fever. This disease
& Dysentarie should never be separated inso
far in a system of Physic. In very many cases
it is Febrile affection. Cullen has kinds. 1st
from Indigestion, 2d Billious, 3d Mucous, 4th.
Celiac, 5th Lunteria, 6th Hepatiren.

Causes. It may arise from the ordinary, causes
of Fevers. The Putrid [effl??]. from Animal &
Vegetable substances caused. In digging up the Lead
Coffins in the French Revolution, the stench caused
a violent Diarrhoea. The Dissecting Room has this effect.
Cold especially after heat. It is often a translation
of other diseases to the members - as in the Gout.
Certain minerals cause it. The Flesh of certain
animals & Fish - Scrophulous Inclination of the Glands
of the Mesentaric - It is generaly a Febrile affection
when it commences & it usually continues - Their
is an inflammation of the Intestines which is not
indicated by the pulse. Bleeding therefor is
usually necessary. The use of Astringents must be
defined by the Heat & state of the pulse.
Terra Japonica or Kino - R 1Ʒ Kino 11Ʒ Gr [illegible]
Sugar Aq Mentha Water - Decoction of
Log Wood is often preferable to many other,
Galls are useful - in substance or infusion
with Laud _ & Brandy. Rhee was much used
I am not particularly in favour of it.
Sugar of Lead is an important remedy. It has
cured when other have failed. It may be

combined with opium. It must not be used
indiscriminately. Enemeta are often useful.
Sometimes astringent ones _ in Limewater, Solution
of Kino in Limewater _ Infusion of Galls -
Preparations of Iron in long continud cases.
Magnesia is often used _ it corrects the morbid
action of the Stomach - also Lime Water.
Emetics - are adapted to the Biliary kind _ I
recommend small nauseating doses of Ipecac.
Diaphoretics useful in this disease - Flannel
next the skin _ In recent cases with, dry skin
Diaphoretic are very important. Blisters are
useful in this as in Dysentarie (which see)
Issues for obstinate cases are proper _ A mild
salivation with a little opium are proper in
cases from Warm Climates. Exercise & [illegible]
are often very useful. A change of air has
cured some obstinate cases.
Cholera Morbus.
Dr Cullen defines it, vomiting & purging of Billious
matter, spasm of the muscles & anxiety. It is a
Febrile disease. It appears in our climate mostly in
Summer, sooner or later avoiding to the heat.

is usually a disease of July & Augt in Great [Brit???]
Symptoms are - it attacks suddenly, seizes at once
with vomiting & purging, the matter if often green
or yellow, a griping & distressing sickness, pulse
often at first is full & strong but very soon it
sinks low & weak. The matter discharged is mostly
Billious the patient sinks very suddenly, it attacks
usually at evening. If often assumes the form of an
intermittent. The Repulsion or translation of Gout to
the Intestines is a cause sometimes & is very formidable
Worms have caused it, also certain poisenous plants
as Fungi or mushrooms, certain fish as crabs, oysters
particularly if a little Spoiled, also minerals as Copper
arsenic & mercury, also the Bile of some venomous
animals. The cure was pointed out by Hippocrates,
Cure. If there was much pain he recommended Opium
with diluent drinks. Sydenham used a similar practice
When the vomiting is present diluent drinks as Barley
Water, chicken Broth are to be given to assist the
evacuations, after this is sufficient, if the vomiting
continue with spasm opium, with mint water is to
be given in 1, 2, or 3 Gr, _ If after the vomiting is

stopped the skin becomes hot & painful we
must again give the diluents. If Tenesmus is
present Enemas of the same are proper & Glysters
of warm Water, Linnseed mucilage with opium
are useful. In many cases it is proper to give
the Opium at the first moment without the diluent
drinks, especially if the patient is old. I go
according to the strength, countenance, & pulse.
If the patient is much reduced opium by the
mouth & Laud, by Enema are to be first used,
afterwards the Diluents. In the worse cases I first
resort to stimulants as Sinapism - [He????y]
then in dangerous cases as soon as I am called
to the ancles or calves of the legs. Blisters are
useful in the Febrile cases, Warm Baths are
good, Sometimes we have to use more
powerful Stimulants as Brandy, Spiced Liquor,
Venesection is proper when the habit & pulse
radical it, is said to stop the vomiting but
usually is improper. Drinking of Cold water
is not usually allowed but Dr Cleghorn says
the Spanish resort to it. Also the ancient Physicians

Columbo & other bitters were once recommended
but it is not now much used. In general
the Bark is not employed but in the Intermitten
Cholera it is the remedy to be used. Arsenic I
have never known to be used. When the
Abdomen is swelled & painful fomentations
externally have been useful.
Cholera Infantum.
The vomiting & purging of Children is more common
to America. It prevails in all large towns mostly
though not entirely. It appears earlier or later
according to the season. Here it appears about the
middle of June & July. It usually affects children
from 3 or 4 weeks to 2d,, years. It commences with
a relax or Diarrhea - or it may begin suddenly
with vomiting & with some Fever. The first vomit
is only the Milk _ then comes the Bile both upwards
& downwards, often there is much pain, uneasiness
but have less spasm than adults. Pulse is quik
& weak, heat of the head is considerable & the
feet cold, in the progress a delirium ensues -
& often a complete Mania, thirst attends the

disease & the drinks are apt to be vomited.
The eyes become torped, strabismus & dilitate
of the pupils - The vomiting & purging continues,
It sometimes runs out in 24 hours & may continue
several weeks. The weather has much affect
on it. A long contined state of warm weather
seem to be a remote cause. Obstructed persprite
is another, Dention, worms & summer fruit are
also supposed to be. Dentition no doubt is,
but is not the principal cause of this complaint.
Worms I believe are a cause, they will cause
Fever. The eating of Summer Fruits I believe may
be a cause - The Pine apple I believe is - the temperate
use of fruits I believe is rather a preventative.
It is a form of remittent & Intermittents _ all these
disease are but modifications of one another -
also Dysentaria & Diarrhoea.
Prevention & Cure. In the cure the 1s indication
is to evacuate the Bile _ mild chicken water -
chamomile Tea, Attention is then to be paid, to the
stools, when a tenesmus is present mild cathartics
are to be used _ Calomel & Laud _ Ricini _

Opium must be used to allay the puking &
purging _ the cutacious Julep _ or rub down
Opium 1 Gr - 11℈ Gr Arabic _
The use of Emetics & Cathartics is a mid point
When the fever is high, with heat & stupor as
may be useful but is not commonly to be
used, sponging with cool water is good,
Brandy & warm wine to the abdomen. In the
worst cases Warm Bath _ or warm fomentation are
to be used. The Tonics are useful. Small
doses of Allum with Laud, have been used
with success here. I have used the Kino mixture
when astringents are proper, also the Tinct Kino,
Some vegetable astringents are Geranium Maculatum
boiled in milk are useful. It may be used
from the first of the disease. A Tea of the Black
berry Root has been much used. To ally the
irritation of the Stomach a weak infusion of
mustard is very effectual. The Acitat of Lead
with Opium is an important remedy. A child
1 Year old may take 1, 2 or 3 Gr a day. Small
doses of Sulpt of Lime should not be

neglected. Blisters are of much effect. I have
saved several patient by them. The stop the
vomiting, remove the stupor & in the chronic
stage are excellent stimulants _ Should be
much used. Sinapisms to the wrists & ankles
weak are to be used. In long continued [cur??]
small doses of Calomel with Opium is said to
have done good. I have used it only as a
purge. Dr Millar gave it an alterative.
15,000 to 18,000 children die of this disease every
year in the U.S. Our children in the Spring &
Summer should be used to vigorating [exer??es]
, straw Beds & Cold Baths should be used,
Salted Food is proper _ condiments, except Pickles,
salt & pepper in moderate use, proper dress
wine warmed, to prevent the disease - The
nurses should be attentive to their own food.
A change of air will affect more than any
medicine _ Sea air good.

Dropsies
By a Dropsy we mean a preternatural
[calvict??] of serum in some of the cavities.
Dr Cullen seems not to be well acquainted with
the nature of this complaint. He has put it [a???]
the cachexia _ but this class is without a
general Fever. Dropsies are Febrile affection.
They often combine with other Fevers. & are
to be cured by removing the Fever, The Febrile
nature of dropsies has been long known, even
in the riegn of James the IId,, - This doctrine was
taught by Dr. Rush.
Hydrocephalus.
This is more Febrile than the other species, Dr Cullen
defines it, A soft swelling of the head, with a
gaping of the Sutures. There are 3 kinds 1 of the Ventricle
2 of the Cranium between the skull & Dura mater
3 Exterior - The third kind I have never seen
unless in Anasarca. The Second kind occurs
often but is usually connected with the first -
It is very slow, the Bones [illegible] enlarged
usually commences in the Fœtus. 4qts & 1pt
was found in a patient 9 years of age. a patient

of mine. It is often connected with Scropula.
Of Acute Dropsy of the Ventricles.
Dr Cullen considers it as a species of Apoplexy.
He defines it. Gradually arises attacking infants
with lassitude, small Fever, pain in the Head
small pulse & dilitation of the Pupil. He puts
among neurosis very improperly. It is a Fever.
He has an imperfect knowledge of it.
Helurden describes it thus Fever pain in the
Head, dilitation of the pupil. comes on slowly
nausea, heaviness, delirium, [??ght] painful,
redness of the cheek, lithagy disentary the
extremities. He has said nothing of Strabismus.
nor obstinate constipation. Dr [illegible] [illegible]
inactivity, drowsiness, feverish, appetite weak
nausea & vomiting, skin hot & dry face
[illegible], pains in the head, often in one part,
alternates oft with the Stomach affection,
dislikes the light, grinds his teeth, bowels
confined, pulse nearly regular at first,
The eyes is oft turned inwards, vomiting
increases & is an important symptom, the
symptoms of Fever are now more evident

delirium ensues- Epistaxis [somet??], The
seconds stage is marked by change of
pulse, lethargy, strabismus, eyes partly closed
vomiting ceases. decreased sensitivity, Soon
after the pulse again becomes Regular -
[illegible], convulsions, locked Jaw. The above
is Dr Linus description of it. Every case of Dropsy
of any kind I have ever seen was an Fever. Some
are Intermittents, Rimittents & Typhus. Hence I have
put them into the class of Pyrexia.
To Dr L. description I would add. Dr Rush says
that dilitation of the pupil, & strabismus have
sometimes been wanting. Usually nausea is present.
Double vision Dr Rush has observed also an
acute hearing in some cases. He has seen it end
in Hemeplegia. In the second stage a peculiarity
of the pulse is observed 8 or 10 strokes will beat
at 60 then 6 or 8 more will be quicker. The
sudden violent pains in the head are present.
It is acute. One case terminated like Hydrophobia.
There is reason to believe the Liver is much
disordered. It is very sensible to pressure in this

disease. Is mostly an Infantile disease but it may
occur in adults particularly with other Dropsies
Out of 26, 8 was from 2 to 5 years Old - Dr [Riscards]
I think it occurs most in 3d year, also I think it
is apt to attack Females about puberty. Is more
frequent in adults than is usually supposed.
It has been divided into 3 stages by the pulse
This has been objected to _ Dr Whit. 1st,, Increased
Sensitivity. 2d Decreased Sensitivity. 3d The Paralytic
Stage - has been the division of some. This
has some objections.
Causes Are such as act direct on the Brain
or through the medium of the System _ The
first is from Blows, Falls &c,, and undoubtedly has
been the cause. by causing a Fever. I have seen
several cases that could be refered to any
other cause. Dr Rush has known it from a
concussion, In more cases the cause was
some Fever, Worms may induce symptoms
similar to Hydrocephalus. The state of the Bowels
will determine this. If costive it is Hydrocephalus
if worms the Bowels will be relaxed. The
irritations of worms may perhaps give

rise to genuine cases. Dr Rush says that acute
Rheumatism has caused it, but it [does] is not I
think the pain in the limbs causing a [str????]
in the limbs in the last stage. Pertussis is a
cause. I have seen a case. Dr Rush supposes
there is a close connection between it &
Consumption - also Dr Percival. Many cases of
consumption have their eyes dilated. The Lungs
are oft much affected by this disease.
Exanthemalous diseases are a cause of it.
Such as Scarlatina, Small Pox &c,, , I believe the
sudden repulsion of Itch will cause. I have
known cases of it. I know a case of Herpes
that will bring on affection of the Brain if it
is removed. The drying up of discharges behind
the Ears, Dentition _ are remote causes. Is often
connected with Scrophula. or occurs in families
liable to Scrophula but I do not know that it
occurs at the same time with Scrophula. We
inherit a predisposition to it from our Parents.
Fevers are shaken off by physicians as a cause.
Dr Rush mentions Typhus as a frequent one.
I have not met with any that have [illegible] -

From Typhus that seemed to end in it
Dissections show much inflammation have
been discovered. Hydatids have been found in
the Brain. The nature of Hydatids is not well
known. Often it is only a [illegible] State of
a Lymphatic Vessel. It is also often a foreign
body - as a worm inclosed in a cyst of water.
The Water refuses to coagulate by heat. Dr
[Wood???n] says but this is incorrect. It arises
in different cases sometimes it will not others it
will.
Cure. The 3 most important are Venesection
Purging & Blisters. Is necessary to bleed largely
& frequently General & Topical - arteriotomy has been
proposed. Purgings are important, some cases
I have cured by then what I supposed were
true cases. Large purges are necessary
mercurials are proper in larger doses. in every
stage. Diuretics as Digitalis _ I have not tried
have been recommended, They deserve
attention. Calomel should be combined with it.
Stramonic has been noticed by some Physicians,
is closed allied to Digitalis.

Blisters to the Head neck & Temples must be
used so as to evacuate largely _ They are better
than any other remedy _ Though they will
often fail. I depend most on Blisters. They never
should be omitted,
I believe this disease may often be prevented if not
cured. Drastic mercurials purges & Epispastics have
been used with success in cases that appeared
to Incipient Hydrocephalus. Besides these remedies
are Vapour Bath but I believe it is of little use
Mercury was first used in it in 1775 by Dr Dobson.
Dr,, Percival afterwards used & mercurial course.
Since that period most physicians have employed
but there is a difference in the opinions of Physicians
about its efficacy. That it has mostly failed there
is no doubt, I never have made any case of
cure by mercury. while several have recovered under
the Lancet, Cathartics & Blisters. Dr Percival says
that it operates without salivation - it is very difficult
to excite a salivation in young Children & we are
told that a profuse perspiration will take place
from the Head. It has been recommended to
guard against laxity of the Bowels & also


costiveness in the use of Mercury. I have nothing
to say in favour of mercury for this disease. It
has failed in the hands of most other physicians.
Proff Monroe used it in 20 cases & every one was
fatal. In 4 of the cases the mouth was affected,
a little, in 2 a salivation was excited. In many
cases there is no effusion of water into the Ventricles,
& only a determination of Blood to the Brain.
An accelaration of growth is said to take place
after a cure whether this was accidental or not
I cannot determine.
Errhines have been employed in this disease but
I know not of this doing good. Emetics I cannot
recommend. In Old People I should place some
considerable dependance on them. Cold applicat
to the Head relieve the pain. Might not Bark
be useful in some cases? _ I have seen a case
assume an Quotidian Intermittent. The success
in Hemeplegia should lead use to pay some
attention to it. We see that it is useful in
a periodical Inflammation of the Liver & Lungs
& why not of the Brain. I recommend the use

the trial of Arsenic in this disease. I believe it
will cure it. Camphor externally should be used
on the Head to translate the disease. Dissolve
it Ether. Exercise & Cold Bath should be used to
prevent a relapse _ They are apt to return after a
cure. There is something peculiar in the aspect
of persons who have been cured of it. A peculiar
staring appearance & wild. Besides I would
use one or more issues into the arms, often
purging, attention to the first appearance of any [F???]
or change of Climate. The convulsions of this disease
are distinguished from those of others. In this one
side, arm, leg &c will be more affected than the other
or others, this is not usually the case in other diseases.
Ascites. An intumescence of the Abdomen, Dr
Cullen has several species - o
Anasarca. An Intumescence of the whole body
He also makes several species of this. He was
not well acquainted with the nature of Dropsie
HydroThorax. Difficult Respiration, particularly
when lying, He makes several varieties.

Ascities
Water is usually the fluid, occasionly puss, oil &c,,
The Host often die from a melting of the fat of the
Omentum - in [Sum?na]. In general there is Swelling of
the abdomen, by applying one hand to it & striking
on it with the other it may be destinguished for
pregnancy &c,, Sometimes a Tumour of the Spleen
will be mistaken for it. When there is water there
will usually be felt a fluctuation, It may be
confounded with Tympanities but it is [illegible]. It
is often difficult to determine whether it is effused
into the abdomen or not. It is an obstinate kind
of Dropsy & is almost always combined with
obstruction of some of the viscera, perticularly in
those who have passed the middle age. I have
met with cases in young people brought on by
Hooping cough & other disease which were easily
cured. It is often combined with Anasarca
and it is still more incurable. Children recover
more easily from Dropsy than old people. When
there is a complication of the 3 kinds it is
very apt to be fatal.

Hydrothorax
The signs of this are often equivocal, the breathing
difficult particularly in a hoyzontal posture a
sense of weight & pain at the Stomach, usually a
swelling of the feet. When the last is the case the
breathing is easier & the reverse. The pulse seldom
regular, is usually intermitting, and slow. All these
symptoms are equivocal. Sometimes an undulation
can be perceived but often an anasarca of the Lungs
will exist & this cannot be discovered _ A kind of Hectic
usually is present. Gout sometimes produces all the
symptoms _ Angina Pectoris may be confounded with
it. Aneurisms of the Thorax has been mistaken for it,
The symptoms may vary according to the part of the
artery that is diseased. A fleetting, intermittent pulse
usually attends the aneurism. Syncope & fainting;
& an increased pulsation in the Carotids. It may also
be confounded with Empyema for Pneumonia may
terminate in either. If Puss is there it will not
be readily absorbed. Puss internally is usually
marked by Hectic but this also often attends
Hydrothorax. Asthma usually comes on suddenly
with a wheezing noising in breathing which is

not the case in Hydrothorax. Angina Pectoris the
difficulty of breathing seems to rather imaginary
The left side is usually affected a pain is
produced by pressure & there is a complete
relief between the paroxysms. The Heart is usually
disordered in Angina Pectoris.
Hydrothorax is the worst kind of Dropsy but I have
cured several cases. Dropsies of all kind often
end suddenly in Death particularly [in] this kind.
I know we inherit a predisposition to Dropsies.
from our parents, but it may be kept off by
proper remedies. I have abundant proof of this
being a Hydropic predisposition. Whole families
will be affected with Dropsy.
Cure for the Different Dropsies
In Hydrocephalus, we spoke of the necessity of
VS,, and of the febrile nature of Dropsy & the use
of VS,, a long time ago. Dr Rush has mentioned
cases from some old writers that were cured
by bleeding. One case was cured by an
accidental rupture of a vessel in the Lungs.
There is much testimony in favour of this remedy

Though I have done much with it yet I cannot
agree with Dr Rush that a cure can be asily
cured by VS without Diuretics. The Fever is not
always continued & I have cured cases by Bath
Emetics are often useful. The Squill & Linea
are useful most when they nauseate or vomit
also Digitalis. I believe many obstinate cases
would be cured by vomiting. It has much
effect on the Absorbents. Buboes are often [illegible]
by it, Small & repeated doses of Ipecac are
powerful & useful. Much may be expelled from it.
Sudorifics are useful. In Anasarca & Hydrothorax
are useful but of little effect in Ascites, I use
the Dovers Powder, I recommend this practice,
particularly in case brought on by Cold, Intermittent
& Rheumatism. Small [quant??] of Ipecac Opium & [Gums],
[crossed out] 48Gr [crossed out] 12Gr [Opium] '2Gr divide into 8 powders Purges are often useful.
Mild Cathartics are occasionally good but
usually little dependance is to be placed on them.
Cream of Lantor is a mild one. Alous Ganmby &c,,
Podophyla combined with calomel is worthy
of notice. An infusion of [illegible] with [illegible],

Diuretics have been much used. Digitalis
is one of the most celebrated. Is not adapted
to all kinds. It has succeded in febrile habits
better than in stronger ones, Where there is much
fever & arterial action it is less proper. It has
been said to be useful in those cases brought
on by Ardent Spts,, & I have found this nearly
correct, It is useful in these cases. Has been
supposed to fail more often in Abdominal Dropsy
& even to do injury. In some cases of Ascites it
has however been useful. I use the Saturated
infusion. In all the forms it has done least in
Ascites. Tobacco I think not inferior to Digitalis.
The medium dose of the [Injection] Tincture was 80 Gt of Dr
Fowlers but I could use 1/2 this dose. In some
cases of ascites I have performed a cure with it.
The Squill I think more important than either
Is good to prepare for the Lancet: has much
power over the pulse. It has been disputed
whether it was ever serviceable unless it
caused nausea. Dr Horne thought it must do it
Dr Cullen thought not. I am of Dr H,s opinion.

Is more useful combined with Nit of Potash to
determine to the Kidnies. For I have done best
with it in union with Sub. Sulpt of mercury. In
Hydrothorax Calomel has been combd with it.
The Alliacious vegt., have occasionally been used
best adapted to Atonic cases. Terebithic
medicines have sometimes performed wonderfull
cures in every kind. The Lilliquore plants have
done good in Dropsy of low action. The Senega
is a good Diuretic. I can bear testimony in its 
favour, it sometimes fails - but often succeeds
surprisingly. I have used at the same time
Corrosive Sublimate with complete success. In
particularly adapted to low cases of Dropsy,
Elaterium has been recommended but I have
used it but little. The Juice of Cucumbers have
also said to have cured. The Volatile Tinct
of Guac. is Diuretic. Opium is suited to
cases of Atonic kind it has a diuretic effect.
and it has been useful in opposite kinds of
Dropsy. It does not reduce the good effects of Digitalis.
but I think increased. Dr Westar thinks a

a cure was performed by it. Sugar I would
propose to be used. Cream of Tartar is an
important remedy. Dr Ferriar cured 6 cases of it of
10 by. it. It produces its effects soon; Nit & Act of
Potash are often useful. I comb Nit. Pot. with
Digitalis for fibrile cases of Dropsy, also with
Squill. The Act of Potash (Sal [D???tices]) I have
not used but it is recommended. The Sulpt of
Copper I think will be useful, also the [Ammonient]
of Copper. Alkaline remedies have been
recommended. Dr Sydenham trusted the cure
in those too weak for Cathartics to Alkalies.
Dr Monro is in favour of them, They are oft
combd,, with Juniper berries - &c,, - The ashes of
Tobacco I believe [?xert] no other effect than by
its alkaline power. The Vol Alkali deserves
more attention than it has received. Opium
sometimes increase the Diuretic power of Alkali
& also of the Balsams, Cantharidics are many
times powerful Diuretics but often do not exert
this power. Particularly useful in low cases,
In Hydrothorax of Old people it has been considered
as preferable to any other. Opium was combd,,

with. A large dose with Camphor once caused
a cure. I have employed this many times
with success. particularly in cases with cutaneous
affections. The Vit. Ether has been recommended
by Dr Fathergale & I have seen advantage arise
from its use. Shall patients be allowed to satisfy their
thirst? It was formerly considered as necessary to
deprive them of Drinks. In the last 40 years they have
been allowed mild drink to satisfy their thirst. I
allow as much drink as is wanted provided
it is not cold. Cold Drinks are improper. Good
Cider 2 or 3 qts a day has been said to have
cured anasarca, Mercury. I shall make some
remarks on, The use is not a modern practice.
Dr Lind says that he has often cured obstinate
cases by a slight salivation & Diuretics. It deserves
to be mentioned that during the use of Mercury
the Urine increases as soon as salivation begins
& when this stops the swellings increase & the
Urine decreases. Some East Indies practitr think
it does hurt in the Dropsies of there climate.
A patient with Hepatitis & dropsy was cured
by squills after mercury have failed.

Dropsy is sometimes combine with a Syphilitic
Taint & Mercury will be proper. The [Car????]
Sublimate sometimes excites a diuretic property.
Repelled Itch sometimes causes Dropsy, an
Inocculation of the Itch has cured. Mercury has
often done good in Dropsy but I believe it has often
done much harm. It induces much debility.
Anasarca is sometimes the effect of an mercurial
course. A slight salivation only should be used.
Scarification of the Lower extremities is a modern
practice. In Europe it has of late been used.
Blisters in Dropsy of pregnant women are proper,
on the lower extremities. I have never used the
Cold Bath & from theory disapprove of it. Still
it has been recommended. [crossed out] Cold is one
of the great causes of Dropsy. Anasarca has been
suddenly produced by exposing the body in air
at 32°,, _ Exercise is proper if it can be indulged
in. A change of climate is good. particularly
from a Damp to a dry climate. The weight of
our bodies is increased by damp air. The heights
of Mexico would be a good situation. [Damp??]
had a Dropsy in California - He was cured

by a warm sand Bath, Friction by oils should
be tried. I have used it in anasarca but with
moderate success. How much the oil does I will
not attempt to determine. Oily frictions in an
eccymosis of the Leg from a wound performed a
cure. I have nothing to say of [Paracent??y] It
is only a palliative & should not be resorted to
very early. Nature sometimes accomplishes a
cure. I have very often known Anasarca & some
cures of Ascites removed by Nature. Sometimes
worm diseases follow the Spontaneous cures of
Dropsy. Of Hydrocele I have little to say. One
case I knew caused by Gout & was removed
by a return of the Gout brought on by stimulating
the extremities. I have seen an extensive Hydrocele in the
last stage of Typhus removed by internal remedies,
Dropsies are many times periodical & are usually
connected with Intermittents, Are usually of the
Tertian Type (See Dr Lynde.) The principle remedy is
Bark. Arsenic I have not used & from theory I
think would be of little use. In Intermittents
Dropsy often succeeds for the want of Bark
rather than to the use of it; . .

Hemmorrhagy.
Cullen defines it, Pyrexia, with a flow of Blood
independant of external violence. He has several
genera. They have a common character & the treatment
is very similar.
Epistaxis _ Cullen defines, A pain in the Head, Redness
of the cheeks & discharge of Blood from the Nose
He has the Idiopathic & Symptomatic. The disease
appears most among young sedentary people &
who take very nourishing or stimulating food
or in Old people who take strong Drinks.
Pains in the head, brightness of the eyes, beating
of the Carotids, swelling of the veins of the Head
usually precced Epistaxis. The flow of Blood is
immediately preceeded by an itching, of the Nose
With a shivering after its ensues
Hemoptysis.
Cullen defines it A Redness of the cheeks, [Disp????]
cough, tickling in the throat, with expectoration of
Blood, He makes [two] several species Idiopathic &
Symptomatic He should have added Arthritic.
Pulmonary bleeding often succeeds to Epistaxis when
the last is stopped. It usually occurs from 16

to 30. & in persons of particularly habit & formations.
It is an hereditary disease. My own Family inherit
it. The [illegible] confirmation of the American Savages
chests still continue to resemble the Asiatic
ancestors. The Bleeding is most apt to occur in the
Spring. The Habit is costive, cold extremtities, an
itching is felt in the Larynx, a cough, a saltish
taste in the mouth followed by blood of a
florid colour. Sometimes the patient expires from
a loss of Blood but rarely. Is less dangerous
when it occurs from external violence, still
less when it is vecarious discharge. When it
becomes periodical it is very dangerous.
The Causes have been divided in Remote
Remote Cause. Malconfirmation, sedentary
habits, intemperance in eating & drinking, violent
passions, suppression of accostemed evacuation,
bodily exertion, Catarrhs, external violence
repelled eruptions, bites of poisenous animals,
Narcotic stimulants, exertion of the Lungs.
Exciting Cause. All the remote causes, Rarity
of the atmosphere. Hence more frequent in some
places than in others

Hemmorhoides
Cullen defines them. The patient [exper??] a
pain in the Head, loins & anus, Tuburcles about
the anus which distil blood, sometimes blood is
discharged without tumours. He has several
species. It may appear at any time but often from
30 to 60th year, Have been observed as early as
5th year. It may happen in all ages & both sexes _
I think is more common in Females, More common
appears in Plethoric habits, that are sedentary.
Some consider this as hereditary. Is usually
preceeded by a painful sensation about the anus
costiveness, mucous discharge sometimes occurs. There
is more or less fever - pulse full & hard. It has
prevailed epidemically - as in our Yellow Fever.
The pulse is said to be singular but I have seen
nothing peculiar in it. There is an increased
discharge of mucous from the anus sometimes to be
met with - which are called White Piles. Is wont to
appear in persons of an Apoplectic make. An Apoplexy
or Palsy have occurred on a cessation of the discharge
The small Tumours are caused by effusion of
Blood into the cellular substance; often [illegible]

painful, suppurate & form Fistula which are
much connected with Thoracic affections.
Mennorrhagia. Dr Cullen considers it as
an increase flow of the menses. If it is true
that true menstrual discharge does not coagulate
this difinition is incorrect for this discharge
does coagulate. He defines it. Pains of the
Back, lines, & Belly; copious discharge of the
menses. He has several species. It is remarked
by [su?mmising] that many of the abortions are
deformed ones. Every Abortus may be said to be
morbid. In some animals as of passions aborti
are natural processes.
Hematamisis is usually the effect of violent
vomiting, external violence or is a vecarious
discharge.
Hematuria. When Blood is discharged in
males from ther Urethra, it is from the Kidnies,
Bladder, vesic. Seminalis _ From the 2 first it may
arise from violent exercise, Cantharadis, Balsams,
Gout, It is often of the active kind. In Scurvy
it is passive. Worms in the Bladder have

caused it. Also the breathing of Hydrogen _ as in
the case of Dr Woodhouse _ 1 qt in 24 hours was
discharged. It may occur from other causes
as in other disease - Is frequent in the bites
of Rattlesnakes - is a striking symptom. The Liver
is liable to Hemmorrhages -
Remedies. Of the active kind VS,, is the first
remedy. It must be greater in one kind than in
another. We must often resort to it in the first
instance. As to the quantity circumstances must
determine, sometimes so far as to cause faintings.
Dr Cullen supposes a spasm of extreme vessels is
conjoined with it, hence recommends Blisters,
Without any theory I recommended then
particularly in Hemoptysis [Mennorrhagia]
[In the last of the remedies] In the last I have
seen them produce effect when all other things
fail. Large Blisters on the inside of the thighs.
Purges are imporant - in Oiles & some case mennorhagia
particularly. Dr Hamilton has seen Hematins
in females cured best by Purges, Acrid ones
are to be avoided - & mild ones used, such as the
Neutral Salts - Nit. of Potash, In mild bleeding for

from the Lungs is good' Common Salt is used
by Dr Rush. & is a good remedy but it is more
stimulating than some others. Sulpt of Potash I
think posseses some good properties that others do
not. The action of some metallic salts is not well
known. I have not used them. but they have been
used even in the most active cases. Alum,
has been much exlated. In uterine Bleeding it
seems to be particularly useful. It has been given
for it with Opium. Is also combined with Kino
which I suppose to be the same as Terra Japonica.
Prof Cullen began with 5 Gr of Alum for a dose _
In Mennorrhagia I use Allum 1Ʒ Galls Ʒss
in doses of . [Digitalis] Allum is much used
by the Philadelphia Physicians. Issues are also
often useful _ particularly in mennarhagia. I have seen
them used after other important remedies had failed.
Phosphoric Acid I have never used, nor can I say anything
of the use of Arsenic in Hemmorrhages but I believe it might
be useful in active ones. I know not why Antimonials
have gone out of use in Hemmorrhages; they were much
celebrated formerly, 3 or 4 gr of [C??????d] Glass of Antimony.
Ipecac is celebrated particularly in Hemmorrhages [illegible]

the Lungs & uterus. In my own hands it has been next
useful to the Acetate of Lead & sometimes better. I have
always found it unnecessary to give it large doses - 2 - 3 or 4
Gr every 2 hours so as to excite a little nause is the
best way to give it. Even vomiting will many times
increase its good effects yet in Hemoptysis they may
sometimes be hurtful. though I believe much less often
than what is usually considered. Dr Curric [showed]
endeavoured to show that Digitalis was improper in
Dropsies & also that is useful in Hemmorrhage. Other
writers have spoken well of it in active Bleedings.
In Mennorrhagy depending on increased action which is
usually the case Dr Ferriar has found Fox Glove a
very important remedy. I combine small doses of Nitre
with it & with very happy effect. I have prevented
several abortions in women who were liable to them.
In Hemmorrhoidal Bleedings Digitalis is said to have
done considerable good. I must however say that
in Hemmorrhages Digitalis is less to be depended
on than many other remedies. Opium is used by
some. Formerly I abstained from its use on
account of theoritrical Ideas but I now use it
& with much success. There is no managing the

the Cough & irritation without Opium. It is usually
combd with Ipecac or Antimony. In Piles it is less
called for. In Mennorrhagia it is very important. I
give it in form of Dovers Powder. In some habits
subject to Hysteria it is invaluable when there is
Mennorhagia. Lead was formerly used, but was
afterwards neglected from the idea of its danger. It
is now brought into use. I have principally used
the Acetate of Lead. It is important. In Epistatis I [I]
have used it less but occasionally it has been
remarkable successful. I once gave 8 Gr for a dose
in Epistaxis. In Hemoptysis I have saved many
lives by it. In teterim Hemmorrhage I have used it
most. In general 1, 2, or 3 Gr every two hours is the
necessary dose. I combine Opium with it which
prevents the griping. I have never known any
permanent bad effects arise from it. I [som???]
use Ipecac with advantage with it. Its good
effects appear soon - if it does not before 36
hours it should be laid aside.
An antiphlogistic Regimen must be employed in
Hemmorrhages. Cold I cannot recommend in the
Hemoptysis - though the cold Bath has been used.

I have employed cold to the greatest extent. I even
have put Ice into the Vagina in mennorhagy. Since
the use of Lead I have found Cold less necessary
in Active Hemmorrhagies. The distinction into Active
or passive I retain.
Diabetis
Is undoubtedly a febrile affection & accordingly I
shall place it under the class of Pyrexia & near the
Hemmorrhagies because it is a Profluvia. Cullen has
placed it in the class of Neurosis _ order Spasmic. He
Difines it thus. A preternatural secretion of Urine,
He makes two idiopathic species - 1st The Saccharine
where urine resembles Honey. 2d,, The Insipid,
He has also symptomatic as Hysterica, Arthritis
Artificialis _ The latter is increasing among us
The patient is very thirsty; the quantity of urine
exceeds the quantity of Fluid drank. Is said
usually to be clear, I have commonly seen it of
an Amber colour. The taste is more or less sweet
more like Honey than Sugar, The quantity of
saccharine matter is immense - 3q ℥ in 24 hours
have been discharged. is said to resemble that

of the Fig. The urine will undergo a viscous ferment.
A few cases of insipid are to be met with but
very rare. Only 4 or 5 are recorded. I have seen
one from Gout.
The Causes are not well understood. There is
sometimes a connection with Intermittents. It some
times is owing to misplaced Gout. Is supposed
to be more frequent in Drunkards _ said also to
arise from the Drinking of Mineral water.
Whatever stimulates the Kidnies I believe may
cause it. It is not communicated by contagion.
The bites also of certain animals - mineral
poisens have been mentioned as causes _ but
the last I am not inclined to believe ever caused
it. There seems to be a connection with water
Brash. The Appetite is voracious, skin hot &
dry, a peculiar odour from the body & Lungs,
The same Habites is perceptable in old Drunkards
The mind is weak _ anxious & wavering.
Emaciation advances and at length spasms
ensure. The Lower extermities become edomatus
skin becomes cold & moist. These symptoms
vary in different persons.

The teeth often decay. the end of the Urethra is
affected with smarting & becomes excoriated.
Theory. Some suppose it to depend on a disease
of the Stomach (Dr Oliver) Dr Rush, supposes the
Liver is designed to Animalize the Blood &
[illegible] it of Chyle, & that a defect in the action
of this organ accounts for this complaint. That
the quantity of Chyle is disproptioned to the
action of Liver in this disease & that the Chyle
is directed to the Kidnies. His theory is ingenous
but that is the whole of its merits. In 20 cases
of Dr Cullen the Liver was unaffected. There
is more reason to suppose it depends on a
morbid action of the Kidnies, They are found
much diseased as found by Dissection. In
one of the patients the Serum of the Blood was
turbid. [Cullens idea that the urine is proportioned].
The skin & the Lungs partake of the disease, They both
emit the Hay like odour. A phymosis or an
ulceration of the Glans Penis is usually present in
men. The Bones are also affected. It is still
controverted whether saccharain matter can be
found in the Blood. It is now considered as

established that it cannot be discovered there,
(Dr Woollaston). It is familiar to us in Pyrosis that
the stomach secretes an immense quantity of fluid
different from the healthy. The Liver also does a
milky one in some disease. The Maw of Fowls
is capable of acting two parts. While it is a
membrane only a thin watery fluid is secreted
but during Incubation it becomes glandular &
secretes a milky fluid for the nourishment of the
young. Such is the Pigeon. I believe the Kidnies
to be the seat of Diabetis. It has been induced 
by stimulating Diuretics - such Spt. of Terbinth,
Cantharadies, &c,, - The Kidnies are not the only
organs that secrete the saccharine matter but the
Lungs & Skin do both perform this action. Sometimes
the Kidnies are little altered by a Diabetes after it
has continued sometime.
Cure. I believe is now little understood. It has
generally been considered as incurable, of late we
have testimonies of cure being performed. The remedies are
Astringents, Tonics, [Stimulants], Blisters, VS & Diet
Allum was much recommended by Dr Dover

& Dr Mead but I believe these cases were
different from the present cases. Dr Wisten has
cured one case by it. Other astringents as Galls _
have done good. I have heard of one case cured
by the use of Nit. of Silver. Chalybeates have lately
been recommended in large doses. Dr Haller used
Rhie in small doses. In those cases owing to
Diuretics Rhie is recommended. Catharadies
are also recommended but I should be cath
to use such stimulating substance. Repeated
Blisters are used. Of late Phosphoric Acid has
come into use in France. Also Phospt of Soda.
as purges. I think I have Seen the last do good.
Dr Rolla placed much confidence in the
Hepatised Ammonia. I have never usd it.
Emetics have been employed & theoretically
I suppose they would be useful. Diaphoretic
are useful _ as determend by practice. Mild
Saline Diuretics are said to be useful. Of late
VS,, has been considerably exalted. It is not a
new remedy. The symptom certainly indicates
it. The Nepheter Water is a remedy mentioned
by some.

A diet of Animal Food is said to have cured
almost every case by Dr,, Rollo. He allowed
a full course of food. It has been confirmed
by other practitioners. It has succeeded in this
city. by Dr Physic - In my practice it has not
answered my expectation. Of late in England
it is said that a relapse is apt to follow Rollo
plan of treatments.. Saccharine substance should
not be used. In health they stimulate the Kidnies,
It is increased in the urine by taking it into the
stomach. Dr Willis allowed his patients to
use it. I have suceeded with opposite plans
of treatment & best with vegtable but we have
much more testimony in favor of the Opposite.
This terminates Pyrexia -
Neuroses
Tetanus
Cullen places it in his order spasmi with much
proprity. It was discribed by the ancients. There
are several modification of it distinguished by
the names Emprothotonos. Opesthotonos & Frismus
The first is very rare & it is even doutted

by some whether it even exists (Dr Morely)
Dr Cullen defines it A spasmodic rigidity of
most of the muscles of the body, He has some
symptomatic varieties and with propriety -
as Febricosa, Verminosa, Hysterics &c,, _ Trismus
is defines it a Spasm of the muscles of the Lower
Jaw - It is only a modification of the whole
disease. I have seen arthritic & inflammatory
Tetanus - I cured a case of the inflammatory by
venesection. Dr Cullen never saw a case of Tetanus
his history is taken from Dr Chalmers,. The 1st symptom
is a stiffness about the neck, swallowing becomes
painful & difficult, a violent pain is fellt at
the bottom of the Sternum. A dread of water is
sometimes observed. If it becomes general, it then
extends to the muscles of the Back & then to the
extremities. The arms & fingers are the last to be
affected. Towards the close the Tongue is often
thrust outwards. A remission may occur &
continue 10 or 12 minutes and then the spasms
will return. Respiration is difficult, the mind
is usually not much affected, though in all
the cases I have met with there was a

a fatuity. the Bowels are costive. towards the
close there is a pricking sensation along the
Back. Some cases are rapid, terminating on
or before the 4th day, beyond which the disease
is less dangerous. It does not go off suddenly
in favourable cases.. A Kind [mo??] slow is
described by Mr Bay one which is milder,
It rarely proves mortal. It continues 5 months
or more and then comes on an acute fever
which cures the disease. I would recommended
Dr, Girdlestone,s Treatise on Tetanus. The [divi??]
into Idiopathic and Symptomatic should not
be neglected. The Narcotic plants produce the
first such as Liamonium, Cicuta &c,, The first
is produced by wounds. It attacks at different
periods after the application of the wounds,
From cold is common, it occurs sooner then
from wounds. I have not learned how long
it happens after the bite of Reptiles.
Remedies. The 1st,, is Opium, or it we
ought to place our chief [??ependum] on it.
It has done more than any other remedy, It
has been recommended to be given in a

the commencement, increasing the Doses.
Sabatin mentions a case in which 36 qr
were given in 24 hours. Still larger doses
have been given. 1500 qr were once given in
17 days & the patient recovered. Dr Plenck
mentions 12 cases of Tetanus from wounds 4
of which recovered under the use of Opium
It should also be given in Enema. It has
been supposed that it acts still better when
[in??cted] with Brandy. Probably the Stramonia
in Tinct, of the seed in 2 ʒ every 2 hours &
also in Enema would be useful. It should
be tried. Injections of tobacco is recorded
to have cured a few cases. One patient was
killed with it & another cured. It should
be used with caution. In suspended
respiration it has done good & it has
also done hurt. Musk has been given with
advantage, Large doses should be given as
ʒss every 2 hours. Dr Wethering recommends it.
In one case I gave it with much advantage
To these remedies must be added Brandy

Wine and Ether. These have generaly been
combined with Opium. Bark is an important
remedy. Dr Rush was much in favour of it.
Cures have been performed with it, A West Indian
practitioner used it before Dr,, Rush. Though Dr
R. has the credit of bringing it into use. To
Dr R. we are indebted for its general use.
Some of Dr R. cases were not truly cases of
Tetanus. He also gave wine with Bark.
so that it is uncertain how much the Bark
did. (Via Dr, Masely) Dr Hosack has cured
2 cases by Bark & Wine. The Bark must be
useful in those cases connected with Intermittents.
I have recommended Arsenic in the Tetanus
but I have never had an opportunity of
using it in genuine case. I have heard of 2
cases treated successfully by it. I should
not give it in small doses. I should give
46 gtt every 2 hours, of the Mineral Solution
such doses are safe. I recommend it from
Theory. I have seen Tetanus [illegible] cured by it
Might not large doses of Mustard be useful. ?
It has been recommended by Dr Hunter.

Opium with the Carbt of Potash has been recommended
& given in the Hospitals of Germany with advantage,
Dr Clarke recommends Mercury. He gave it 2 or 3 [times]
gr twice a day, He combd Bark with it & at night
he rubbed it on the
Mercury has been employed as a preventative &
has undoubtedly been of use in many cases. I have
seen advantage from it in a case of threatening
Tetanus. A considerable rigidity of muscles had
taken place in the neck _ the effects of the
Mercury soon come on & carried off the rigidity
Several convulsions attacked afterwards came
on but were cured. I think much is to be
expected if the irritation can be excited in the
System. Sulpt of Copper has been recommended
but I place but little faith in it. The same
may be said of Ol Amber. The Barbadoes

Tar has been used but is a weak remedy.
Much has been said of the Cold Bath. It was
an acient remedy. There is much division about
the use of it. In Cayenne it is said to have done
much good. Dr Wright brought it into notion.
Dr Currie entertained a high opinion of it. (via
his Reports) Dr Clark says that with him it has
always failed. In other conclusions Dr Curries has
done much good with the Cold Bath. Dr Mosely
says that in the warm climates it is useful but
that it has been often incautiously used so as
to have done much hurt. It is certain that
Damp & Cold applied to the system, cold
Drink - has caused the Tetanus. Large draughts of
cold Water produced it in Soldiers of the new
arrived regiments in the East Indies. It has also
many times produced sudden Death. I have
seen one case caused by drinking cold water.
The Warm Bath I believe has often done good
and is not attended with danger. Patients are
sometimes so fearful of the Bath that they should
not be forced. into it. Dr Chalmers relates a case
in which Death was caused by the Fear

it has done no permanent good. Large bleedings
do hurt, small ones relieve the present symptom.
Issues are important, & in some cases keep off
the paroxysms. Blisters & Sinapisms are useful
both during the attacks & the intervals. When
applied an hour or two before the attack
have the effect to lessen it. Purges & often
active ones are useful. We have much testimony
of the use of them. Emetics have been used
particularly to keep off the paroxysm & they are
often effectual not withstanding there determination
to the Head. Full vomiting from Ipecac, Sulpt
of Zinc or Copper as have before the attack are
to be used. I have near experienced any bad
effects from these. Though I have never cured
with them yet they often are important. The
Digitalis has been employed & from Theory
we should conclude it would be useful
in cases of much irritability. I have used it
with benefit but never have cured with it.
Is proper in cases combined with an Hydropic
Diathesiss. Opium is usually necessary. When

there is a plethora & vs is proper it would do
hurt. When it does not induce sleep it
will increase the disease. [crossed out] The [crossed out] Hyoscyamus is
not a new remedy. Lately has said to cure
The Stramonium has come into use. To much
has been said of it. The public expectations have
disappointed. I have frequently moderated &
sometimes cured with this remedy. D Jennings
of Va) informs me that he has cured many
patients with it, even cases attended with
fatuity. Begin with 1 gr doses of the powderd
seeds. In generally plethoric habits & [illegible]
to the head it will usually be improper. but
I have seen exert very good effects in this disease
I have made some cures with it & often have
palliated the symptoms. In some periodical cases
Tobacco externally applied is important according
to Dr Currie. He applied a cataplasm to the
scrobiculis Codis about 1/2 an hour before the
attack was expected. He performed a radical
cure with it thus. It certainly makes great
impression on the system, applied in this manner.

Alkalies, Soap, Lime is recommended to be put in it.
Warmth applied to the Spine from a Hot Iron
has been recommended by a French Physician.
It would probably fail. I saw the Iron applied
directly applied to the Spine in a case of Hydrophele
but it failed. Blisters & Sinapism large
& powerful applied to the different parts should
be tried. They certainly would not be hurtful
and probably would often do good. Bleeding
has been used & recommended by some but
usually it would be proper. I cured one
case from a wound. The patient was a plethoric
Habit. I gave Small doses of opium & applied
Cantharadies to the wound. Usually it is not as
inflammatory disease. It may be cured
spontaneously. Would it not be well to try
innoculation of vaccine, variola Itch &c? _
The Bowels are constipated & Purges if they can
be used should be resorted to. It has been cured
Drastic ones, when arising from cold. Dr Jones
of North Carolina has communicated a cure to
me cured in this way. He first gave 20 gr of
Calomel & Jalap a.a. - 4 more powders were soon

given which evacuated the Bowels & brought a
little remission; They were often repeated &
length a cure was performed. It was induced
by a cold. Enemita may also be resorted to,
Persons who recover, retain the impression on this
system. Dissections have thrown no light on
this complaint. The Blood is said not to coagulate
after death but resembles that in persons destroyed
suddenly by Lightening or other accidents:
Catochus
Nearly resembles Tetanus. Catochus is chronic & may
last for years, Tetanus is acute. Of this disease I have
seen but one case. There is not as much affection
of the Chest. The remedies are the same as in
Tetanus. The case I saw recovered by the assistance
of Nature. It is an Idiopathic affection & never
arises from wounds,, perhaps does from Worms.
Raphania
I have never seen. Defined by Cullen thus
A spasm of the Limbs, with convulsions, & pain &
occurs at periods. It has been epidemic in Europe.
Linnaeus supposed to arise from the eating of
the seeds of a species of Radish. This I doubt

It is an Intermittent assuming the form of the
Tetanus.
Convulsions
Dr Cullen defines it thus. A chronic irregular
contraction of the muscles without sleep. There
has been made many species or varieties.
distinguished by the causes from which they arise.
The treatment will be considered under Epilepsy
Epilepsy
Cullen Defines it. A convulsion of the muscles
with sleep. His species are 1st: Epilepsy of the Brain from
no apparent causes, 2 Sympathetic, arising without
any apparent cause but preceeded by the [illegible]
[Eliptica]. 3d The occasional arising from an 
apparent Irritation which goes off when the cure
is removed, from Narcotics, passions, Debility &c,,
It differs from Convulsions by it being attended 
with insensibility, returning periodically &
sometimes continues for years without affecting
the mind. Such was the case of
J Bonaparte. The patient are struck down
suddenly, the muscles are violently agitated
The urine, foeces, semen & even Blood are

forced out, froth at the mouth, after the convulsion
a sleep ensues. The patient is not sensible that he
has fitts. This insensibility will distinguish
Epilepsy & we can discover by this whether this
is feigned or not, Apply something stimulating to
the Nose or Prick with the pin. It is often feigned.
The changes of the season & the moon is supposed to
have effect on Epilepsy & I have some belief in it
certainly they have on maniacs. Excesses of any
kind certainly hasten the paroxysms. It is also
hereditary. Frights on the youth are often a cause.
Cases from terror are common. When it has survived
in youth & continues beyond Puberty, we may
conclude it will continue for life.
Dissections. Shows induracions, effusions,
abscesses, stony concretions in the Brain. The last
are constantly found in the healthy Brain as
in the Pineal Gland Potutary Gland. This is found only in the
Human Brain except for the family of Apes
Remedies. Physicians differ about the propriety
of Bloodletting. It occurs in so many different habits
that there is little surprise that it should be so.
In most cases I have bleed but I believe

The Belladonna is nearly allied to the foregoing and
has sometimes cured. Tonics. Bark is spoken well
off by Dr Cullen. He combd it with Chalybeates. I have
not used it but it is much recommended by some
phicians. It must be long continued. There are
many other Tonics which are as useful as Bark.
The Misletoe & the Orange leaves have been much
esteemed: Dr Johnson chewed organge peal for a
Chorra with which he was troubled. The
Valeriana Sylvestris is perhaps the most important
Tonic. The testimony in favour of it is great. I
have seen two cases yield to it. Large doses
should be taken begin 1Э and increase to iiiƷ _
Some of the most obstinate cases which have been
treated with Anthelmintics without success, the
Valerian has cured. Bark combd with it is often
useful in cases allied to Epilepsy. Camphor is
said sometimes to have cured but I have
never done much with it in Epilepsy. Vx Gall
is said to have been effecacious. Hoffman
gave 1Ʒ of inspissated Gall every day. Musk
has been employed advantageously. It has been
injected into the veins without doing the least

injury. Assafoetada has been recommended. I have
not used it but believe it would be useful.
Tin has been used & is said to have done
good. The preparations of Iron I believe to be
new useful. 2 or 3Ʒ every 24 hours & long contind..
The Ammonient of Copper has done much
good in Epilepsy. I have performed cures with it.
Doses begin with 1/4 of gr or still less _ combine it
with some aromatic. It must be long continued.
Some of apprehended that its contd,, use would
do injury to the system but I believe there is
no danger. The Sulpht,, & Oxide of Zinc have
sometimes done good, & sometimes failed
I have not employed them but little. The
Acitate of Lead has been used. The Nit. of
has been considerably employed & with various
success. It has sometimes done good. We must
begin with small doses & increase. I have
sometimes used it. I have never performed
any genuine cure, by it but have alleviated
cases, it is a powerful Tonic. In debility
with Nocturnal pollution I have cured with
it when other remedies had failed.

Mercury has been supposed to be useful.
& we have cases cured by a salivation. The
Sulphuret has been recommended - also Calomel
Mercury has been combd,, with Valerian. It
promises to do good but in my hands it has
not yet done much good. It should be used 
with cation. Sac. Sat. has been employed.
Dr Rush had some faith in it. He supposed
it cured by causing a new disease in the
Bowels and not by its Tonic power.
Arsenic says Dr Cullen has been used in it. & I
believe it would sometimes yield to it. Cold
Bath has used but it is not adapted to every
case. When there is a determination to the head
which is usually the case I think it would
do hurt. By keeping the patient awake at the
hour at which it is expected to return, has
much effect on the disease. The horizontal
position has much effect on it. Change of
climate has often cured it. Diet will have
much effect on it. The passions should be kept
calm, excess in venereal pleasures have induced
it. A life of too much Chasticy will also

some effect in producing it. It is not always
desirable to cure it; a worse disease may
follow as Phthisis Pulmonalis.
Chorea [S]
Cullen defines it thus. Affects both sexes, always before
puberty (incorrect) occuring between the 10 & 14 year.
with involuntary motions, affects one side of the
body. The motions are irregular. - It usually does
attack before Puberty but it has occurred in
pregnancy. Rarely is fatal, Many times goes
off of itself. The eyes become dim, countenance
pales Often appears in maniacal Families.
this I have several times observed to be the case.
Is not as common in the U.S. as in Europe.
Cure. Dr Sydenham proposed to cure it by
alternate purging & bleedings. I have once bleed
with much success _ a case yielded to 2 or 3 bleedings
and mild cathartics. Purges are important.
(via Hamilton). He has often cured it by
vigerous purges. I think he is riding a Hobby
to hard, though his work contains much
that is useful. A milder course has succeded
better with other physicians.

Digitalis has been employed but I believe with
but little success though some cases would be
treated well with it. Tonics are important
Bark has relieved a case under my eye in where
it had existed many years. Dr Cullen speaks
well of the Bark. Antispasmodics with the Bark
have been successful. The chorea of preg
woman has been relived by them but I believe
the evacuants would do better. Dr Heberden
recommended Myrrh. Dr Mead used chalybeates
& the Cold Bath and very successfully. Dr Currie
has tried the Cold Bath and says it always
failed. Still I believe it would many times be
the best remedy. Metallic Tonic have been
happily used. Nit. of Sileca promises to do good.
Will Arsenic do good? _ I understand it has
cured it _ It promises to do much. Foetada
& Valerian have cured it when it arises
from Worms which after cause it. Blisters
to the Back & Spine have cured it. Electric
according to Dr Currie has done good be I
belive it will many times increase the dis
When it defends or repelled the itch the

[the] [new] disease should be excited. What
effect would the Rhies Radicans have on it?
From some accidents in the P.A. Hospital a
patient with Chorea was poisened with it &
after 10 days was recovered nearly.
Pertussis
Is a convulsive spasmodic cough, with a
peculiar [wheez??], Cullen defines it thus
A contagious disease, a convulsive cough, of
a sonorous sound _ with vomiting _ At first is
attended with the symptoms of common cold
a little expectoration at first, which increases
the face becomes florid, Bleedings, evacuation of
feces & urine during the paroxysm. At first there is
considerable Fever with evening exascerbation, It
does not usually continue. It is often a case
Intermittent. The paroxysms are various. It
seldom lasts, less than 4 week oft continue [5] _
It frequently ends in a Hectic Fever, & other 
diseases. It is favourable if the paroxysm
end by a vomit, small Bleedings are also
favorable. Is dangerous when it appears at the
[???thing], when there is [de?????]. It is epidemic