Virtus et Honor
Comites
Omnium Hominum
qui sunt boni et assidui ipsorum
professionibus

Notes
taken by
George Barber from the
Lectures delivered or given by Sir Geo. Tuthill
on
The Practice of Physic
London February 17th 1821.

 
 

Class 1st Pyrexiæ. Character.
After shivering, or a sense of coldness, a quick
pulse; increased heat; with intermission
or interruption and derangement of functions,
diminuation of strength. This class contains
five orders. Order 1st Febres. Character.
Pyrexia, after languor, lassitude, and other
sign of debility, without any primary local
disease.
Intermittentes. Fevers arising
from marsh miasmata, consisting of many
paroxysms. Without fever or at least with
evident remission, returning with remarkable
exacerbation, and in general with
shivering: one paroxysm only taking place
each day.
Genus 1st Tertiana.
Similar paroxysms after an interval of about
48 hours. The accessions taking place at noon.

2
Each paroxysm of an intermittent Fever
consists of three stages. viz. The cold, the 
hot, and the sweating stages. The tertian
differs sometimes with respect to the length
of the paroxysm (that is) 1st. The paroxysm not
continuing above 12 hours. 2nd. The paroxysm
not containing 12 hours but more at 14 or 16.
It differs sometimes in the return of the
paroxysm, (that is) 1st. Returning daily, with
equal paroxysms, alternately resembling.
2nd. Returning every second day, with two
paroxysms in one day. 3rd. Returning daily
with two paroxysms one day, and one paroxysm
on the next. 4th. Returning daily with a
a remission, were remarkable between the
odd & even day, than between the even & odd.
It differs sometimes in the symptoms, (that is)

3
1st. Attended with drowsiness. 2nd. Attended
with spasms. 3rd. Attended with efflorescence
of the skin. 4th. Attended with inflammation
5th. In being accompanied with other diseases.
6. In cause. It is attended sometimes
with remission (that is) one paroxysm is not
quite over before the other commences -
Quartana. Genus. II. Similar paroxysms, after
an interval of about 72 hours. The accessions
taking place in the afternoon. This species
also varies in type or period, 1st. Having one
paroxysm every fourth day, & none on the intermediate
days. 2nd. Having two paroxysms
every fourth day, & none on the intermediate days.
3rd. Having three paroxysms every fourth day
and none on the intermediate days. 4th.
of the four days the third being only free
from fever, & the paroxysm alike every fourth

4
day. 5th. Having daily paroxysms, and similar
every fourth day. It varies in symptoms,
being complicated with other diseases 
and likewise in having remissions.
Genus III Quotidiana. Similar paroxysms
after an interval of about 24 hours; and
the paroxysms taking place in the morning.
It differs sometimes as well as the two above
mentioned viz. the Tertian & Quartan. 1st
Universal & returning at the same hour 
in the morning. 2nd. Partial. It differs
also in being complicated, and attended
with Remission. Treatment of a simple 
intermittent fever. No remedies to be applied
during the paroxysm, but between. The first
class of remedies are tonics, both vegetable
and mineral. Of the former the Peruvian Bark

5
or Cinchona lancifolia of the Pharmacop. which
is to be given, if the patients stomach is able
to bear it, in powder, dose ʒj every four or six
hours. Some states of the stomach if present
must be corrected before giving the Bark,
which is to be effected by an emetic, as the
Antim Tart. dose. lss every 10 minutes or 1/4 of an
hour until it operates. The bowels sometimes
are disordered without the stomach being
effected, if so give a purge of Rhubarb 2j
Calomel gr vj. If the Bark produces a diarrhea
add to every dose Opium gr 1/4 if after this the
diarrhea continues, then change the bark
& take the Angustura or Cusparian Bark
& give it in doses of ʒss every four hours. These
barks have the greatest effect when given 
in Substance conjoined with an aromatic
as Canella gr ij vel iij to every dose of the Bark.

6
Other barks have been also employed for
the cure of this fever - viz. The Jamaica Bark
dose ʒj. Another kind of bark procured from
the island of St. Lucia. It has been asserted
that the Barks owe their property of curing
an intermittent to some particular
principal which they contain. Bitters
have been used by some as Quassia, Gentian,
Camomile, Wormwood, Columba. Of the
mineral Tonics wh. are used, Arsenic claims
the first place and especially if there is an
visceral disease, then its effect will be most
remarkable, it is given solution, called Fowlers
solution, & the Liquor. Arsenicalis of the Pharmacop.
one pint of which contains of Arsenic
gr 64, we commence at first with gt v wt. is 1/24
of gr. increasing gradually to tea drops 1/12 of gr every
6 or 8 hours three times a day. Other minerals

7
have been given as Silver, Tinc. Sulph. Dose gr 
to gr v. Cupri Ammoniatum sel Sulphur gr
every two or three hours. During the fit - if the
symptoms are not violent & the paroxysms
short, then we must do nothing during the
continuance of it, but if on the contrary the
fit is violent & of long duration, then we
must prescribe something, not with an intention
of curing the disease by putting a stop
to it as this we shall be unable to do, but
in order that is with a vein to abate & shorter
the paroxysm - we must therefore employ
such medicines as will accellerate the
sweating stage - diaphoretics as Pulv. Antim
gr v ter horis together with Aq. Ammoa. Ac 
℥ss omni horâ combined with small doses of
Antim. Tart. these medicines must only
be given during the cold & warm stages. Boilg
water is to be given with Ant. Tart. in small 

8 
doses during the hot stage. Some have thought
proper to employ during this stage than medicines
used in inflammatory fever & bleeding
but Dr. Tuthill recommends this plan only to
be used in extraordinary cases. In the cold
stage symptoms as stupor, coma, with extreme
coldness & numbness may come on, in which
case we must employ strong stimuli as
warmth to the body by fomentation & friction
with Volatile liniments externally; internally
Ammon. Aromat. ʒss to Mist. Camph. ℥j every
hour : if there should be great vomiting in
this disease, then employ effervescing medicines
with Opium as five parts of Carbonate of Potash
on Soda to four parts of Citric Acid or Citric
Acid liv to Mist Camph. ℥v K ossii gr 30. If the
above remedies have been unsuccessfully used
during the cold stage in order to restore warmth

9
then we must employ mustard cataplasms to the
soles of the feet, & internally Alcohol or Spt. Ather
Nitros ʒss with Mist. Camph. & R. Cardamom. ʒj
every hour. If during the hot stage the symptoms
are violent & there is great action in
the arterial system accompanied by throbbing
of the carotid and temporal arteries - here we
must employ cold to the head & warmth
to the feet, leeches to the temples, cupping,
purgatives wh. will act quickly, the saline
as Magn. Sulph ℥j to ℥iss - injecting at the
same time the alimentary canal to create
the discharge. Some recommend curing an intermittent
by producing violent action in the
system just before the paroxysm takes place,
they give an emetic as Ipecacat. grxr Ant. Tart.
gr I & with opium as K opii grt 40. but Sir
George Tuthill thinks they seldom have 
the power of stopping the progess of the disease.

10
The plan of treatment to be pursued in
Tertiana Triplicata, that is when there are
two paroxysms on one day & another on the next
is the following - I before mentioned that the
Barks must not be given during the paroxysms,
as the irregular paroxysms prevent you
from giving the bark in the regular ways
you may prescribe it in a different manner,
(ie) to give it in considerable doses
at short intervals on the morning of the day
when you expect the regular paroxysm to
come on, as for instance 3ss at 8 o clock ʒj at
nine ʒij at 10 and ʒij at eleven - by which
method if you are successful in stopping
the regular paroxysm, you must continue
giving the Bark but in smaller doses &
at longer intervals, thus you may possibly
prevent the irregular paroxysms from
coming on the next day. If the Bark does

11
not succeed in putting a stop to the paroxysms
after being employed in this way for a week
or ten days, it may be owing to a morbid
state of the stomach & bowels therefore give
an emetic or purge as mentioned in the
case of a simple tertian and then renew
the Bark and generally the result will
be favourable. Here arsenic will be inadmissable. 
When you have Paroxysms at regular
intervals but without an intermission
(ie) the symtoms abating but not entirely
having the patient & unaccompanied by
visceral disease - this case will be more
difficult to cure being a remittent than
the preceding ones - here your object will be 
to procure an intermission, which you must
endeavour to do by giving an emetic during
the remission as Ant. Tart gr ij vel iiss if this
should not succeed, experience says Sir George

12
has proved that opium will have great
effect here, more especially if the disease is
accompanied by a nervous irritation of the
system, and its effects will be increased if
given after an emetic as Pulv. Ipecac. C gr xv
Tr Opii grt xxx, this is generally followed by a
profuse perspiration & an intermission takes
place, then you must immediately begin
by giving the back in regular doses, which
in the end cures the complaint. When the
continuance of the fever is owing to a morbid
action of some part of the body as the alimentary
canal then give Calomel gr vj Pulv
Rhai 2j ad gr xv. If after you have attempted
to correct the morbid state of the system,
& used the remedies above mentioned for
several weeks without the compliant being
subdued or abated, then you may suppose
there is visceral disease, which is more 

13
prevalent in a Tertian than a Quartan, &
in the latter than the Quotidian - when these
fevers are of the remittent type - Sir John Pringle 
conceived that the liver & spleen were
the parts chiefly affected in this disease
he found in France when the disease was very
prevalent in his time, that a long continuance
of this fever or frequent relapses produced
visceral dropsy or jaundice, & he remarks,
wh. Sir Ge. Tuthill says may be taken
as a practical lesson, that if Bark is given
here it increases the disorder, a tumor also
is generally found in the region of the liver
for which he prescribed bleeding, salines and
aperient purgatives. It has been remarked
that the remittent kind of this fever is
that must subject to visceral disease - the
symptoms during the hot & cold stages are
greatly increased. The Diagnosis this - Suppose 
your patient after taking the proper remedies

14
for three weeks without finding any relief -
complaining of pain in the right hypocondrium,
especially when pressed on with the
hand, difficulty of lying on the side, with
a short dry cough - this continues we will
say for a week, then his complexion undergoes
a change, his stomach is disorder'd
with nausea & bilious vomiting. Another
week elapses - the pain in the region of
the liver is now increased, & the tumefaction
is greater at the same time the lower 
extremities are in an edematous state and 
the morbid state of the system is more alarming
all the symptoms becoming worse
ascites takes place with jaundice & visceral
disease and at last the patient is destroyed.
This disease says Sir George was very
prevalent in this Country during the Walcheren 
expedition. In the treatment generally

15
generally in this as well as all diseases, the
exciting cause must be removed, therefore the
patient should not be suffered to remain exposed
to it. Agreeable to this object the soldiers
in the expedition above mentioned, who
were afflicted with this disease, were sent
home, and layed in our military hospitals near
town - the greater number dying in spite
of all remedies wh. were used. Tho' this disease
under many circumstances be a mild one,
still we often find it a very violent & dangerous
one. It is most violent in warm climates,
& perpetually happening in the East Indies
where it is called the Jungle Fever. It also
prevails in mild climates such as ours but
never in cold ones. The mode of treating this
disease by Sir J. Pringle is not at present
considered the most successful, but Mercury
is now employed as the Ung. Hyd. Fort. ℥ss
to be rubbed on the region of the liver or 

16
spleen every night untill a slight mercurial
action takes place, which must be
kept up for five or six weeks, in order to
discover what effect it has had on the disease.
When that subsides the fever generally does
so with it, if not the Arsenical solution
may be here used with great advantage.
The pilule. hydrag. may likewise be used in
doses of gr v night & morning as an alteration.
The fever sometimes subsides when the visceral
disease commences
Continued Fevers.
2nd. Division of the order Febres
Character. Fevers without intermission;
not produced by marsh miasmata; but
with remissions and exacerbations, though
not always considerable; continuing,
& having two paroxysms each day (ie)

17
in the 24 hours - the term continued does not
imply that the patient labours under the
fever to the same degree during the paroxysm 
but that there is a gradual remission
of one paroxysm to the commencement
of the other - this species of fever increase
to a certain height then either destroy 
the patient or begin to decrease.
The Greek writers divided continued fevers
according to their degree of danger, the
moderns however divide them into two
Kinds, inflammatory & nervous - Synocha,
Typhus & a combination of these two called
Synochus. The first of these which I shall
introduce to your notice is Synocha or the
inflammatory fever. Character. Heat much
increased; pulse frequent, strong, & hard; urine
red; the animal functions little disturbed.

18
It is assumed that there is a cold stage,
but of short duration, which is succeeded
by a severe hot stage that may be prolonged
untill death ensues - the cold stage is
very imperfect, the chills & shiverings being
often interrupted & unerved - there is an
extraordinary excitement of the nervous system,
and then of course of all the body.
No particular period of the year is assigned
for the prevalence of this fever, but medical 
writers seem to think that they are
more frequent in the spring - attacking youth
& those in the vigour of life much more
than infants or the aged, and more incident
to those who have been previously
strong than those who are weak. It comes
on with a slight sensation of lassitude
chilliness & giddiness, followed by an increase

19
increase in the body of heat; diminution of
the secretions from the blood; the urine passed
in small quantities & of a high colour, an
increased vigour of the heart & arteries and
great nervous excitement; the skin dry;
the internal surfaces dry & parched as the
mouth & fauces; great sensation of thirst;
the secretions of the alimentary canal lessened
producing costiveness; the patient complains 
of a degree of nausea & oppression at
the chest or scrobiculus cordis; the increase of
temperature in the body arises from the caloric,
which in health passes out of the body by
perspiration, being retained the exhalations
being obstructed; the caloric also which passes
from the lungs in expiration in the form of
vapour (aqueous) which remains at a certain
temperature invisible in the air, but in a 

20
cold at atmosphere as when there is a part
it condenses - there is less of this vapour
carried off; the tongue in this disease is of
a scarlet colour at the sides & white in the
centre, moist also at the sides, the papillae 
at the point of the tongue are more elevated;
the pulse is quick, strong, & full but
its frequency will vary according to the violence
of the attack, it shows no irregularity,
is seldom or never under 96 but will
increase to 120-130 or more - the temperature
of the body being from 100 to 106. If blood
is taken there will be a white coriaceous
surface on the crassamentum; pain sometimes
in different parts of the body as the
head, back, & extremities; this complaint
is not of such a nature as to produce
weakness - the sensibility of parts is greatly  

21
& preternaturally increased as light affecting
the eyes, the least noise appearing to disturb
the patient very much, not liking to be touched;
the organs of taste & smell having an increased
sensibility; flushing of the face; throbbing
of the carotid & temporal arteries; the exacerbation
coming on in the morning &
evening, this latter being the most violent,
difficulty of breathing, delirium accompanying 
the exacerbations, as the febrile symptoms
remit the powers of the mind are restored
when the delirium is of the wild & furious
kind then the sensibility of the different
organs of distinct sensations is greatly increased. 
The first few days there is an increase
of violence in the symptoms after every remission.
The disease terminates in 24 hours but more frequently
in 4, 7, 11, 14 & sometimes 21 days, at these

22
periods the complaint either terminates
in death or else a decrease of the symptoms
that is when unaccompanied by local disease.
This complaint seldom proceeds to the 21st
day; it sometimes destroys the patient but
in general it decreases after it has proceeded
to its height. It usually arrives at its
greatest degree of violence on the 7th day.
Suppose the symptoms to gradually increase
up to one of the periods above mentioned,
the excitement may be so great as to destroy
the patient, then the patient will be said
to have died of excessive excitement as that 
of increase of temperature in the body and
of the nervous & arterial system &c.; great
excitement is generally followed by excessive
weakness. Another way in which
this fever terminates is this, Suppose a   

23
patient labouring under Synocha is attacked
with some local disease as inflammation 
which may seize on some vital part necessary
to life & thereby prove fatal; but the person
is not said to have died of Synocha but of
Phrenitis when the inflammation attacks
the brain. If the infn attacks the lungs thus
of Pneumonia. It does not necessarily follow
that the disease should prove fatal by
the supervening of local disease, as it may
be sometimes subdued, but if he dies his death
is occasioned by one or the other of the modes
I have mentioned. If it does not prove fatal,
it will decline by some new symptom, as
by an evacuation of blood, or production of
some great secretion from it; as Hemorrhage
from the nose - if you discover that the
symptoms & fever abate as the blood flows
it is to be considered as a favourable symptom. 

24
A female labouring under this disease
on the critical day has Hemorrhage from
the Uterus - this is also favourable - & likewise
a discharge from the hemorrhoidal vessels 
- again you are aware that the secretions
are diminished, if then on the 7th day
an abundant flow of urine takes place,
depositing what is called the lateritious
sediment like into red sand & it produces
a diminution of the fever - it is favourable
also if a Diarrhæa ensues, and likewise if
from the skin, which had been very dry
during the progress of the fever, there proceeds
an abdundant perspiration, & that as
it continues the febrile symptoms abate -
a tumor may sometimes arise in some part
of the body under & in the cellular texture
& burst & discharge its contents - at which period

25
if the symptoms abate, it is favourable. This
Fever says Sir George is easily to be distinguish'd
from any other by the excess of excitement in
the heart, arteries & nervous system, by the
greater temperature of the body, & lastly by
the operations of the mind being so greatly
affected. Treatment of Synocha -
Our plan of treatment here must be chiefly
in regard to the excessive excitement, which
prevails in this disease, this must guide
us, therefore our prime object will be to
reduce this excitement to its healthy standard,
& experience has taught us, that this
reduction is to be effected by evacuations,
as diminishing the circulation by opening
a vein in the arm, & allowing a portion
to escape; Blood letting is the most efficient
remedy that we can use in the cure 

26
of this disease; the blood drawn usually
exhibits a white coriaceous surface but
sometimes this does not happen, yet this
says Sir George ought not to prevent us
from bleeding again if the symptoms are
unabated - as this disease generally attacks
those in the vigour of life & the robust we
must commence by taking from the arm
16 or 20 oz. of blood, then to open the alimentary
canal by saline purgatives, as the
Black drops, Magn. Sulph ℥iss or some
other saline aperient, only taking care to
leave the patient more than one dose,
on account of the different effects which
purgatives have on various persons, opening
some very easily, others with more difficulty,
also as there is in this complaint
a preternatural disposition to costiveness -

27
It would be better perhaps if you follow up
the purgative with Infus. Senna to be taken
every three or four hours untill evacuations take
place (ie) four or five. If the symptoms run
very high it will be necessary for you to see
the patient in 7 hours again, & you then
should find that the bleeding had given
little or no relief, & the symptoms still continuing
unabated, take another pound of 
blood; being observant likewise that the
purgatives produce three or four evacuations 
daily. After the bowels have been opened in
the first instance, give diaphoretics, as,
Pulv. Antimon gr v every 6 hours, with the
Aq. Ammon. Acet ℥ss Mist. Camphoræ ℥iss
Liq. Ant. Tart gtt xv made into a drought,
& taken every four hours - This is the plan
of treatment recommended by Sir George

28
through out the complaint, repeating
the bleeding according to the violence of
the symptoms. We must be on the watch
for any critical evacuation taking place,
when it does happen encourage it in preference
to all others, as for instance if
by our diaphoretics we have effected the exhalent
vessels but little, yet on the 7th day
there comes on a profuse perspiration, this
then must be encouraged, therefore we ought
not to use any remedies, which would put
a stop to it, at that period, as bleeding
or purgatives, but must proceed by diaphoretics,
& the patient will gradually recover,
which we shall discern by the symptoms
abating, & the patient expressing a
desire for food. If on these critical days

29 
a tumor arises, the applications to it must 
not be the Letio. Plumbi but warm fomentations
& poultices. During the progress of the 
disease we must attend to the patients diet
which should correspond with the general
treatment - at first therefore giving him barley
water & thin gruel, & as the progress of the
fever is arrested the diet must become more
substantial, light puddings, thick gruel,
in a day or two broths containing some
vegetable preparations - also the patient
should be kept in a light & airy apartment
well ventilated & kept cool. When we find the
temperature of the body above natural & steadily
remaining so, the skin drys no chilliness
being present, then by spunging
the body with cold vinegar & water we
shall often afford great relief to the patient
by the application instigating all the symptoms

30
by increasing the evaporation from the skin.
All that acts on the mind should be carefully
withheld; the external senses must suffer no
violence therefore the patient must be kept
quiet; every endeavour must be used to calm
& compose him - in this way the disease is
usually cured. But the excitation may have
been so great or some visceral inflammation
supervene, in this case therefore the lancet
must be freely employed, together with purgatives
(ie) in the former case, in the latter
the treatment according to the order Phlegmasiæ.
The causes of this disease are the remote
& proximate, this last is very obscure
the former is divided into predisposing & exciting,
the first as it not being incident
to very hot climates but cold & temperate
ones, also not happening at every period of 

31
life &c, the exciting, as the application of cold
to the body when heated, arresting the progress
of perspiration; by the suppression of evacuations;
the repulsion of eruptions; & passions of the 
mind. February 27th 1821. Tuesday.
Genus 5th Thyphus.
Contagious; heat little increased; pulse
weak small, & in general quick; urine
little changed; animal functions much
disturbed; prostration of strength. The
species are, Typhus Petechialis generally
attended with purple spots. This varies in
degree. Typhus Mitior and Typhus Gravior,
Tyhpus Ictorodes attended with yellowness
of the skin. This last does not occur
in this country. In Typhus there 
is a remarkable depression on the nervous

32
nervous system, in muscular strength, &
in all the operations of the mind; diminished
power in the action of the heart
& arteries; the pulse weak, small, & frequent,
respiration a little impeded; nutrition not
going on in the system; The first symptoms
are referred by the patient to pains in the
head & stomach with sickness, lassitude
alternations of heat & chilliness, depression
of spirits, the powers of perception lessened,
loss of memory, inclination to sleep but
it producing no refreshment, the weakness
of the pulse manifest by a gentle
pressure at the wrist stopping the pulsations
of the radial artery; urine is pale
& scanty; the countenance dejected; skin
dry - there are the symptoms generally

33
attendant on the middle species of the Typhus,
but if the attack be severer, the pains in the
head will be violent; with vomiting, severe
pains in the back & loins, great prostration
of strength, the action of the heart more feeble,
dimness of sight with a suffused redness of the
eyes, the patient looses the inclination and
power of assisting himself, costiveness. When
it becomes Typhus gravior, on the first day
of the attack the patient is affected with
all the above symptoms to an extreme, the
blood in the course of the complaint becomes
extravasated, & petechiæ or purple spots appear
on the surface of the body, the pulse
beats from 100 to 130 in a minute, but in some
malignant cases it has found to be slow
as only 30 pulsations in the minute but
this slowness seldom occurs; the heat  

34
of the body not much augmented yet
on withdrawing the hand from the body a
sensation of heat will be felt in Synocha
on the contrary the heat of the body is greatly
increased, but on withdrawing the hand
no sensation of warmth accompanies it -
the complaint still increasing, the powers
of voluntary motion are decreased, & the patient
picks at the bed clothes, there is a starting
of the muscles, & convulsions accompanied
by stupor, this decrease of sensibility to external
objects becomes internal & delirium
ensues, which is very characteristic of this disease,
it is a low, muttering & powerless
delirium; it sometimes takes on a more
powerful form at first but soon changes
into the kind above described; the countenance 
becomes cadaverous, the features

35
contract, the cheeks become hollow, inspiration
is somewhat increased, nose pointed
the insensibility increases, & death finally closes
the scene, but before this takes place the
tongue which is at first covered with mucous
then becomes thick & brown fur & at last
black, the teeth likewise being incrusted
with a dark coloured secretion, the morbid
state of the stomach augments, & coffee
coloured fluid is vomited which is to be
regarded as a fatal symptom - a bloody
diarrhœa, the urine turbid & depositing a
dark sediment; the perspiration accompanied 
by a fetid odour, hemorrage from
the gums, mouth & nostrils, purple blotches
of a larger kind, there is an evident tendency
to mortification & gangrene, besides
the symptoms above enumerated, Typhus
is accompanied by deafness & astriction of 

36
taste & smell; It must be particularly
remembered, that dreadful as this complaint
is, there is between the mild & severe attack
many gradations. It is distinguished from
Synocha by the pulse being small & feeble
heat moderate, diminution of muscular
power, torpid state of the mind, ghastly
& cadaverous countenance with a purple or
livid flush - &c. Typhus has but a limited 
duration, it either proceeds generally increasing
in violence or quickly does so;
it is not usual for its arriving at the height
before the 7th day, but generally continues to the
14th day or to the 21st although it may happen
on the 11th or 13th. When it has obtained
its greatest degree of violence at one of the
periods above mentioned, called by Hypocrates
critical days, it may destroy life -

37
but on the contrary if a recovery commences,
it will be announced by some favourable critical
symptoms, which vary much from those
announcing the same event in Synocha, as
profuse hemorrhage and perspiration likewise
purging, this excess of evacuations would
in this complaint, if they come on, denote
extreme danger which we should be able
to discover by the patient sinking. The symptoms
which are to be regarded as favourable
& critical in this disease are of a much
slighter kind, as suppose, the skin, which
has been very dry, becoming soft & there is
a gentle moisture diffused over the whole
body; a mild diarrhœa; the urine secreted
in larger quantities but not profuse;
the tongue becoming moist & cleaner;
scabby eruptions about the mouth & ears;  

38
the pulse improves; absense of delirium;
an increase of saliva is mentioned by some
writers - these then are the favourable symptoms,
the unfavourable ones are the following - long
continued insensibility; convulsions; sanguineous
diarrhea; petechiæ; a livid colour announcing
incipient mortification; increased
weakness of the pulse; falling of
the lower jaw; bilious vomiting; involuntary
discharges of feces; hiccup together
with impeded deglutition &c. Causes are
the remote & proximate, this last involved
in theory, which is this that a peculiar
agent influences the nervous system thereby
the whole body, the former cause is
divided into the predisposing & exciting
the former as a previous state of weakness
arising from the operations of the mind or body; 

39
by disease; by impeded nutrition; poor diet;
sudden changes of temperature; drunkeness; change
of climate. the exciting cause as being contagious,
it has been established after much observation,
that this disease may be communicated, not
only by a person labouring under it but also
from wearing clothes which has been in contact
with his person; which proves there
must be some material agent which passes
from the patients body, it is called contagion,
we are unable to discover by our external senses,
this agent & what degree of this exhalation
is requisite to infect a person seriously -
if a number of persons be exposed to this contagion
& all be effected, the same phenomena
will take place in all to a greater or less
degree, & fresh contagion be generated, a variety
of facts which warrants this conclusion
may says Sir George be deduced from

40
what occurs in hospitals, jails &c - the system
in which cases undergoing from the stagnant
air some peculiar change generating
this complaint - as intermittents are said to 
arise from vegetable miasma, this is said
to be produced by animal miasma; it occurs
most frequently amongst the poor, who
live in crowded apartments; putrid animal
substance may produce this malady, for
instance, the famous Michat is said to have
died from contagion, by standing for a long 
time over a large jar in which he was
macerating several parts of the human body;
the confinement of the effluvia is not necessary
to produce Typhus as the contagion
may be spread to some distance arising from 
the putrid bodies in a field of battle. Contagion
acts primarily by the lungs, but
on some occasions in a different manner as 

41
wounding the body with an infected instrument,
cutting the hand in dissection or in opening
a body died of this fever. Treatment. In treating
a case of pure Typhus, the mode, is easily
deduced from the history I have given you,
& is this - to increase the nervous energy, to excite
the system to the standard of health
which is done by stimuli exclusively - therefore
all remedies which you would employ
in Synocha will be here inadmissable, bleeding
for instance - (ie) says Dr. Tuthill in the pure
Typhus which is not the species that generally
occurs in practice. Experience has taught us
in all diseases where there is a diminution
of the nervous energy, there is a tendency
to putrifaction; the expulsion of the noxious
matter contained in the bowels is necessary
by Pulv Rhæi gr xv Calomel gr vj - this will produce
one or two evacuations, & not acting

42
with violence - the bowels afterwards to be 
kept occasionally open by Infus. Rhoi - the
stimuli used in this disease are divided into
those that extend their influence gradually
over the whole body, these are the mineral
& vegetable tonics, this last as the Decoct.
Cinchonæ cm Tr. Cinchonæ et Conf. Aromat
gr x the draught to be taken every six hours,
the principal tonic derived from the mineral
Kingdom is Muriatic Acid two
drachms of which should be diluted in a
pint of barley water, & drank daily by
the patient in Typhus Mitior one dram will
be sufficient. No other remedies says Sir
George are necessary in Typhus M., and if
due attention be paid to the alimentary
canal, air, diet (ie) avoiding all animal
food, allowing a free current of air into the 

43
room but not falling on the patient, the
linen daily changed, the floor of the room
washed with vinegar & water to guard of contagion,
all excrementitious matter removed
as soon as it passes from the patient,
he will recover & there will be little or no
danger from infection - Typhus Gravior -
the indications of cure in this is precisely the
same as that in the last - as it differs from
the other only in degree; the remedies to be
used must be stronger, with this exception,
the treatment pursued will be the same as
in Typhus Mitior, giving the same purgative
with the Bark & Acid, the same diet &c,
but if after pursuing this mode of treatment,
we should find the powers of life
become more exhausted, we must then
have recourse to the diffusive stimuli, as
some form of Alcochol, wine for instance

44
the quantity of which to be taken by the
patient must be regulated accordingly, giving
perhaps from 6 to 8 ounces daily - the mode
of determining wether it does good is this,
if it increases the strength of the pulse
without increasing its velocity it has that
effect, but if on the contrary it increases
the velocity without strengthening it, then
it does harm & must be discontinued and
other stimuli be given or other ʒss to ʒj with
Mist. Camphoræ ℥iss every four hours, or Opium,
or Musk as Mist. Moschæ ℥ss to ℥iss with Spt.
Ather. Sulph. ʒss Tr Opii gtt x to be taken every three 
or four hours, & lastly Camphor as Camphor
et Moschae aa gr v Opium gr ss to be made into
pills & taken every four hours - these are 
considered as the most powerful stimuli we
possess. When a severe diarrhœa occurs in this

45
disease, which often does happen, such remedies
must be given as will allay it at Mist.
Crotæ ℥ij Coup. Aromat ʒss Tr Opii gtt xv to be taken
every six hours (si opus sit) if this has not the
effect of putting a stop to the diarrhœa add
Pulv. Crotæ. C. cm Opii ʒss to ʒj & Opiate glysters
made in the following form. Starch ℥ss warm
water 3/4 of a pint Tr Opii ʒj to be injected every
six hours untill the looseness is arrested.
Whilst you are giving any preparations of
chalk the Muriatic Acid must be discontinued,
as this in combining with the Chalk
will tend to produce diarrhœa - sometimes 
good effect have resulted from giving Infus.
Catechu with Pulv. Cuta cm Opii et Comp.
Aromat. If the diarrhœa is unattended
to after it has taken place, it will so
reduce the patient as to destroy life in a very
short period, or eventually do so. If a bilious

46
vomiting occurs, the saline draught in a
state of effervescence with Tr Opii gtt xiiixv must be
given, if this prove ineffectual then it will be
necessary to endeavour to carry the bile downwards
for which purpose we must give a
few grains of Calomel. If excessive perspiration
should take place it must be arrested
by giving the following mixture 
Acid Sulph. grt xv Infus. Rosæ ℥iss Tr Kino ʒj
Tr Opii gtt x. When hemorrhage occurs the Bark
& Acid must be persisted in. If the extremities
are cold, warm fomentations, bottles filled
with hot water, hot bricks &c must be applied
to them giving at the same time the
warm stimuli before mentioned. These remedies
will in general cure the severest 
cases of pure Typhus or very much relieved
this malady is propagated by contagion

47
it will be necessary therefore to guard the
attendants against its effect, cleanliness particularly,
& other more potent means must be
used, as introducing into the air of the room
a vapour arising from common nitre & sulphuric
Acid dropt into it, submitted to a gentle
heat, this produces no detrimental effects on
the patient - vapour also from the combination
of Sulphuric Acid & Salt, but what is more
effectual in removing contagion, tho' highly
offensive & injurious to our organs, is the
vapour arising from the action of the Black
Oxyde of Manganese & Nitric Acid, very
little of this can be brought into a room without
effecting our respiration, therefore its
seldom used but to purify rooms after the
removal of infected patients or in jails
and large hospitals - the means of 
santitation &c must be followed -
Finis -

48
Genres VI. Synochus or Mixed Fever
Contagious: a fever composed of Synocha at
the beginning, & at its progress & termination
Typhus, it is therefore a mixed disease. It
has been maintained by some writers that pure
Synocha or Typhus never exist in Practice
but that Synochus is the only form of continued
fever to be met with, commencing
with excessive excitement. It is very possible
says Sir George that the same disease produces
various phenomena in different persons,
& that discrepancy of opinion which has prevailed 
in the works of Authors, has been
owing, (he thinks), to their not having allowed
for the difference of Constitution, Climate
or Diet. As it is the species of fever which
chiefly prevails in London, you will expect
that I shall give a detailed account of it -

49
There is no determinate period from the commencement
of Synocha to it terminating in Typhus,
it may supervene in a few hours, or not untill
a few days after the attack. And as we are
seldom called in before the second day of the
attack, the first stage is generally past &
the Typhoid stage has commenced this is the
kind of Typhus most prevalent in London,
& only differing from the pure species by having
at its first attack a short inflammatory
stage, therefore we disregard this & treat it
as Typhus, but when, & as it sometimes happens,
this first stage should be violent and
continue for a longer period, the recovery
will depend upon what is done or administered
during this stage. In the first stage
we must diminish & in the second increase
the excitement in the system.

50
At the commencement of this disease, there
is an excessive excitement of the animal
functions; if the organs of distinct sensations
as that of sight, hearing, and smelling, and
from a peculiar state of the nervous system
the function of the mind is performed with
a considerable degree of activity, different
from health; delirium takes place of the violent
Kind requiring two or three persons
to hold the patient; the pulse is full strong
& hard; respiration anxious; heat increased,
the secretions from the blood lessened, producing
costiveness, thirst, diminution of
perspiration, dryness of the mouth & fauces
at length the complaint changes its
nature, the action of the heart & arteries
is diminished in force but not in velocity,
the pulse is weak so that a slight
pressure will stop the circulation in the

51
artery; a stupor of the intellectual faculties
takes place, the patient being insensible to
external objects & lying in a powerless state;
sometimes a considerable muttering low
delirium will arise, so characteristic says
Sir George of Typhus, the muscular energy
will be greatly diminished, & nearly annihilated,
the circulation being lessened, a coldness 
in the extremities will take place -
there is in this disease an extraordinary
tendency to putrefaction, which the contents
of the alimentary canal plainly
point out - the patient, towards the latter
part of the complaint, writhes his body
& slides to the bottom of the bed, & when
there the weakness being so great he
is unable to move himself to his former
position, picks at the bed clothes, is unable

52
to protrude his tongue out of his mouth,
it is encrusted with a fur which will gradually
change into a black colour, the eyes
are sunk & hollow, and there is a livid flush
on the countenance, at last the patient
is destroyed. There is in this as in Typhous
every possible degree between the mildest and
severest form. We shall readily understand how
a just diagnosis is to be formed by its uniformly
consisting of two stages which I have
before mentioned. In forming your Prognostic 
be guided in the early stage of the disease
by the violence of the symptoms or the mildness,
the last or Typhoid stage is that of
danger - this has a limited duration, it
seldom or never attain its hight before the
4th or 7th day & in general not untill the
14th or 21st day, if the patient passes this last 

53
period many have considered it as a favourable
omen; if the symptoms continue increasing
to the 14th or 21st day there is extreme danger.
The symptoms, that would announce an unfavourable
termination (ie) death, are the
same as mentioned in Typhous; the effects
which sometimes arise from the extreme diminution
of nervous energy is that the
extremities are dead many hours before the
patient finally dies. The patient is sometimes
speedily cut of by a sanguineous diarrheœa
supervening. If on the contrary this
disease terminates favourably, which it
after does by some critical symptom taking
place on one of the days before alluded to
the symptoms being the same at those
which occur in Typhous. The causes of this
disease are the remote & proximate, this
last involved in the same obscurity &
the same hypothesis applied by Hoffman &

54
advocated by Cullen, to other disease -
the remote is divided into the predisposing
& exciting cause, with respect to the former
it does not attack or seldom does persons
far advanced in life & young children, those
persons labouring under weakness are predisposed
to it; the exciting cause is generally
contagion, that while this disease exists
a peculiar poison is generated & passes from 
the patient, which poison infects those persons
whose state of body is favourable to
its reception; it is considered to arise from
animal miasma, but sometimes as in Typhous
from other causes - Treatment. This fever being
composed of two stages, in the first
of which there is great excitement in the
second a diminished - therefore the treatment
in different period of the disease

55
must necessarily vary. In the first stage we
must lessen the excitment with as little expense
of strength as possible to the patient, & our
plan of treatment must accord with the
degree of violence in the symptoms. It has
been asked wether bleeding is of utility in
Typhus fever - before answering this question
it will be requisite to ask what is meant
by Typhus fever, wether it has reference to
the pure Typhus or to the Typhus commonly
met with in practice which is Synochus
if the former, Bleeding will be detrimental,
but if the latter, we must reply that
there is a stage of it in which bleeding
is absolutely necessary - it is not however
always to be admitted, as for instance in
large & crowded cities as London, where it
is seldom requisite to bleed, the fever acquiring

56
acquiring the Typhoid stage much sooner, the
constitution being more or less effected, & lastly
we are seldom called in before the Synochal stage
is past & that of Typhus commenced. Now although
bleeding has not been found the
most successful in this town (London) yet we
are informed by the Navy Surgeons that the
most beneficial effects have resulted from
the prompt use of this remedy, & even that the
disease has been cut short - this last effect Sir
George says if almost utterly impossible &
that it seldom happens that we are able
by any remedies which we can suggest
to put a stop to continued fevers - We can
only lessen or modify the violence of the symptoms
the duration of the first stage is by
no means limited. Before having recourse to
the lancet we must consider, wether the

57
continued excitement will not reduce the patients
strength more, than taking from 20 to 30 ounces
of blood from him - & finally we must come to
this conclusion, that it may or may not be
requisite to use the lancet according to the
symptoms that prevail when we are first called
in. Emetics have been considered to have a good
effect when there is a morbid state of the stomach.
Headache is generally to be attributed
to this cause in the commencement of fevers
as an emetic we may give Ant. Tart gr ij or gr xv
Pulv Ipecac. cm. Ant. Tart gr I. Purgatives have
been also used as Calomel gr vj & a few hours
afterwards the Black draught, which must be
seperated at intervals untill it operates. Diaphoretics
may be employed with very good
effect as Aq. Ammon. Acet ℥ss Mist. Camphore
℥ss to be taken every three hours. We must 
watch carefully for the supervention of the other  

58
stage, in which we must have recourse to
bark as the Decoct. Cinchonæ and Muriatic 
Acid as directed in Typhus if the attack has
been slight no other remedies will be requisite
except occasionally attending to the alimentary
canal. But if the symptoms are
more violent it is the London Practice to employ
local remedies rather than the lancet 
as applying leeches to the temples - If in the 
second stage the symptoms appear the same
as those mentioned in Typhus, then the treatment
must be similar. Nothing is a 
greater mistake than to give wine in the 
first stage of this malady as some practitioners
do, in order as they suppose to shorten
the second stage, on the contrary it will
lessen the vigour if the system already much
diminished, & in the end cause the death 

59
of the patient, but if you give it on the sixth
day, when we may suppose the second stage
to have vigour, the most beneficial effects will
be the result. The stimuli here requisite are
the same as those used in the pure Typhus
as Brandy, Opium, Ather, Musk, Camphor
&c. The most fatal form of Synochus is a
complicated one (ie) the first stage does not entirely
cease before the second commences, as we find
the pulse small, weak, & frequent, attended
with violent & wild delirium, or the patient
not able to stir from his bed thro' weakness
yet the pulse is hard, full & frequent & accompanied
also with wild delirium. Our 
practice here will be very difficult & puzzling
as by giving medicines to obviate one symptom
we increase the other, therefore we must be
particularly watchful for the symptoms being
similar, applying warmth to the extremities,

60
& leeches & cold to the head, the rest of the
treatment must be similar to that followed
in Typhus whatever symptoms may arise
Order II. Phlegmasiæ
Characterized by inflammatory fever; phlogosis
or pain in some one external part;
with some internal function injured; the
blood, when coagulated, exhibiting a white
coriacious surface.
When there is redness, heat, pain & tumefaction
accompained by fever, it constitutes
inflammation; which Galen defines to be 
a superabundance of the humoural fluids
that produces the symptoms above mentioned,
others that it is a morbid lentor of the
blood clogging up the extreme vessels; and some
that those symptoms arise from a spasmodic
action of the extreme vessels; and a more 

61
favourable theory is, that they arise from an
increased action in the vessels of the effected
part, & likewise a distention in them beyond 
their natural dimensions, which may be produced
by blushing or friction for any length
of time. John Hunter after making a diversity
of experiments on this subject, came
at last to this conclusion that the temperature
of no part of the human body can
exceed that of the heart, therefore that the
heat in internal inflammations is not
increased, but on the contrary, where the heat
is less than that of the circulation, as when
tumours form on external parts, the Temperature
will be raised. That tensions (ie)
swelling or tumefaction is owing to an incipient 
enlargement of the vessels. That
the colour depends on the red globules of the
blood being able to enter the extreme vessels
in consequence of their distention - That the

62
pain is produced by the over distention of
the extreme vessels, & the entrance of the red globules
of blood. Whenever this local change
takes place it is accompained by some general
change in the constitution, which is denominated
symptomatic fever. The redness in
inflammations is generally greatest at some
central point & gradually diminishes from that
all around untill it is lost, in some cases
however it is more abrupt therefore more conspicuous 
& distinct; it disappears on pressure,
but quickly returning when that pressure is
removed; it is sometimes florid at others' of a
much darker colour. When parts have been
only slightly inflamed, & the person dies & is
examined, no signs of inflammation will
be found, the redness disappearing after death.
The pain too varys, it may be acute, dull,
throbbing, burning, and likewise it may

63
be continued or intermittent, although seldom
the former (ie) lasting with the same violence
without remission. It is also frequently periodical.
Parts which appear insensible in their
healthy state, when inflamed become exquisitely
painful as tendons, ligaments, bones &c.
The sensibility of some parts when inflamed,
as the organs of distinct sensation, become lessened,
as when the Schneiderian membrane of
the nose is effected, there is a loss of smell
altho' the sensibility in another sense of the
word is exquisite, as when this part touched.
The Tumour, arises from excess of blood in the
vessels of the part, & their consequent distention,
as before mentioned, is greatly increased
or augmented by the extravasation of serum,
coagulated lymph or blood; when the former
takes place it is known by the elasticity
of the tumour, when the two last by the
tumour being harder & more permanent (ie)

64
remaining indurated for sometime after
the inflammation ceases. The rapidity in
the progress of inflammation will very according 
to the part effected; in parts that
are compact its progress will be slower than
in parts that are looser as cellular substance
It is produced by a variety of causes, as by
friction long continued, this friction then is
called the cause & the inflammation the
effect, & as in this case the inf.n takes place
exactly where the friction is applied, the
friction is likewise called the direct cause.
On the contrary when a person has been
standing with his feet in cold water & inflammation
of the lungs is the consequence
the cold here is said to be the indirect cause.
It is produced likewise by mechanical and
chemical means, the former as by violence
of any kind, the latter by taking some chemical

65
chemical substance, which has a tendency to
produce that effect. It also is produced by
causes which effect a person but once as the
poison of Rubeola, Scarlatina &c.
Genus VII. Plogosis or Cutaneous Inflammation
the symptoms of which I have given before; the
species are 1st. Plogosis Phlegmone, characterized
by the inflammation being of a vivid red colour,
with a circumscribed tumour, generally
rising to a point; after terminating in abscess,
and accompanied by throbbing pain.
It varies 1st. in form 2ndly in the part effected.
2nd. Species - Phlogosis Erythema (or Erysipelas)
characterized by the inflammation being
of a ruddy colour, disappearing on pressure;
with an irregular circumference; the tumour
hardly perceptible, ending in cuticular
scales, and in pustules or vesicles with burning
pain. It varies 1st. in intensity 2ndly in its remote

66
remote cause. 3rdly in being complicated -
Phlogosis may be succeeded by Apostema or
abscess thus if after some part of the body has 
been suffering for a certain period of time under
an attack of phlegmon, the pain & throbbing
in that part ceasing & the tumour arises
whitish, soft, unfixed, and itching, then we
may be pretty certain that matter is formed.
Phlogosis may be succeeded by Spacelus - the
first stage of which is termed Gangrene, & characterized
by the part becoming livid, soft, little
sensible; and frequently with vessels filled with
ichor; then the last stage or Mortification succeeds,
known by the part becoming blackish 
flaccid, easily lacerable, without feeling or
heat; and with the fætor of putrid flesh; the
injury quickly spreading. It must be remembered 
says Sir George, that these symptoms
are only applicable to external parts.

67
The internal symptoms, (ie) the symptoms denoting
the existence of any of the above mentioned
consequences of infn. internally, I shall relate to
you when considering these seperate diseases.
Most Writers have given a number of sequels
to inflammation, as resolution, affusion, adhesion,
suppuration, granulation, cicatrization
& lastly mortification. It is termed Resolution
when the infla.n subsides or terminates, and
the parts return to their former state without
leaving any marks of disease. It is termed Effusion,
when serum, mucous, pus, coagulable lymph
& blood is effused into some part of the body.
these may all occur as the consequence of infn.
The 1st Takes place when inf.n exists in serous
membranes, which are found in all the circumscribed
cavities of the body, and secrete 
a serous fluid; when this secretion is augmented,
there is a larger quantity of serum effused 

68
which being more than the absorbent are
able to carry off occasion what is termed, Effusion
by Serum, which frequently happens in
the Pleura. The 2nd. is Effusion by Mucous. You
must know that all the passages of the body,
having an external opening or orifice, are lined
by a mucous membrane, as for instance the
mouth, alimentary canal, urethra, vagina
&c. these passages when effected by inf.n throw out
a greater quantity of mucous fluid, more than
the absorbents are able to take up & the consequence
is there is an Effusion of Mucous -
On some occasions when inf.n attacks either a
serous or mucous membrane, a fluid like pus
is produced, owing to a morbid action of the
vessels, as inf.n in the urethra, & not from ulceration,
as also inf.n of the peritoneum forming
a quantity of pus in the abdomen.
The 4th. is Effusion of Coagulable lymph. This

69
often takes place in inflammations of the
Pleura, in which after the patients death, on 
examination is found a portion of adventitious 
membrane, which when analyzed is found to
be Fibrin or coagulated lymph. It is not confined
only to serous membranes but may
occur in mucous M. as in some cases of Croup
it is coughed up; also from inf.n of the bowels,
& dysentery where membranous substances pass
off by stool which if examined will be found
to be fibrin; it perpetually occurs likewise in
cellular membranes, & contributes to increase
the bulk & hardness of tumours situated in that
membrane, often leaving an induration for
sometime & perhaps forever in the parts as it
is very seldom reabsorbed. You know well that
where inf.n exists in any part of the frame
it is accompanied by preternatural excitement
in the vessels, therefore you cannot be
surprised that they sometimes burst, & produce 

70
what is called sanguineous Effusion. Another
change is the effect of inf.n. (viz) Adhesion 
which takes place generally in consequence of one
form of effusion which is that of Coagulated
Lymph. Sir. John Hunter observes that reunion
can take place between parts without
the aid of coagulable lymph. Adhesion often
takes place by means of this substance between
the Pleura Costalis & Pulmonalis, when the
fibrin looses its natural appearance & assumes
that of cellular substance, but before
it undergoes this change it will be found,
if injected with five injection, to be very
vascular. Adhesions will often takes place
likewise in the cellular membrane & abdomen
from this cause. In wounds after coagulable
lymph has been thrown out, there will
appear on the surface small red spots which
gradually increasing, form what is termed 
Granulations. If the wound is brought together 

71
with an intention of cicatrizing it after this
process has taken place, it is then called union
by the second intention but if in recent
cuts the edges be brought together & the wound
unites, it is called union by the 1st. intention
Genus VIII. Opthalmia. Sore Eye.
Is characterized by redness & pain in the eye;
light offensive; for the most part accompanied
with effusion of tears. The species & varieties 
are Idiopathic (ie) when it does not depend
or form a part of any other disease. As Opthalmia
Membranarum which is inf.n in the
Tunica Conjunctiva; is in the coats of the eye.
It varies in degree of external inf.n & in the affection
of the internal coats. Opthalmia Tarsi
with swelling, erosion & glutinous exudation
of the tarsi. It is symptomatic, (ie) when it
arises from a disease of the eye or other
parts. When inf.n effects the Iris it is then
called Iritis. It is likewise div.d into acute & chronic
not being a Physician Complaint S.G. will give parts

72
Genus IX. Phrenitis.
Under this term is included inflammation
of the Brain and its membranes, which
consist of three called Dura Mater, Via Mater
& Tunica Arachnoides. The Brain is divided into
Cerebrum, Cerebellum, & Medulla Oblongata.
When inf.n ceases any of these parts it is called
Phrenitis, although when it occurs in
the Dura Mater the symptoms generally differ
in some respect. Phrenitis is characterized
by vehement Pyrexia; violent headache; redness
of the face & eyes; impatience of light
& noise; watchfulness; furious delirium.
This Disease like others of this Class are
marked by two kinds of symptoms local 
& constitutional; the fever being considered
as symptomatic. It usually begins with
uneasy sensations in the head as a tightness
which in a short time constitutes pain, afterwards

73
afterwards becoming extremely painful
with flushing of the countenance, & redness
of the eyes, the rest at first is only disturbed,
but as the diseases advances it is entirely precluded;
increased action of the heart & arteries
which may be perceived in the carotid & temporal;
chilliness & after a short time a great
increase of temperature; great action in the
operations of the mind untill it is at last
subverted, but this does not supervene untill
the constitutional symptoms have taken place;
sometimes the patient feels the pain in his
head in different parts of it; he talks incoherently
& violent delirium ensues; the eyes
project from their orbits with contraction of
the eyelids; the tongue is red at its sides with
white in the centre; light & noise exceedingly
painful; costiveness; urine scanty & of a red
colour depositing a lateritious sediment; fauces

74
& mouth dry; no diminution of muscular
power; the hearing sometimes lost at others morbidly
acute; the pulse much increase being hard
full & frequent. This complaint has a limited
duration & terminates generally in a short time
as in 7 days but possibly it may last till the
14th or 21st - after it is fairly established it is subject
to exacerbations & remissions, the exacerbations
occurring principally at evening or at
night. It sometimes happens that at the 7th
day the patient dies, not from any symptoms
which we shall be able to discover
in the Cranium, but from the extraordinary
excitement to the entire exclusion of nervous
energy. If it does not terminate fatally
after this manner, it will be liable to
those affections resulting from inflammations
as resolution, suppuration & mortification 
& likewise effusion the result of

75
which is adhesion; if resolution takes place
it is marked by some critical symptoms
as evacuations by hemorrhage from the nose, &
there is a circumstance attendant on such
phenomena which is difficult to be explained
as by a patient loosing only a tea-cupful of 
blood he will be more benefited, than by anything
we can do. Other evacuations will occur
as profuse perspiration; abundant diarrhea;
copious secretion of turbid urine;
hemorrhage from the uterus or hemorrhoidal
veins & lastly a phlegmonous tumour rapidly
advancing to suppuration situated at the
angle of the jaw. If suppuration takes place
in the Cranium an abscess will form in the
Brain w.h will be announced by shivering, the
febile symptoms remitting; the pulse
softer & more full; coldness of the extremities
partial sweats; the fever loosing its marks of inflam.y
fever; the exacerbations in the night are

76
accompanied with increased heat & profuse
perspiration, it then assumes the name of Hectic
fever, which never goes through its course as Phrenitis
proves too rapidly fatal. Infn. of the Brain
is sometimes succeeded by mortification tho'
rarely, it seldom arises but from some external
violence to the cranium, the body being at the
time in an unhealthy state; it is known by
the inf.y symptoms after running very high becoming
suddenly remitting, accompanied by a 
weak, tremulous, & intermitting pulse, and a
cadaverous appearance of the countenance
quickly destroying the patient. This complaint
is at other times followed by serous effusion
inducing compression - the symptoms of the inf.n here
remit, but not followed by any critical evacuations,
& as the symptoms of remission continues
those of compression will advance. this 
termination of the inf.n is not necessarily fatal, as
when the symptoms are slight the fluid may
be reabsorbed. Sometimes purulent effusion

77
is the consequences which rapidly kills the patient
& the symptoms denoting its presence are the 
same as those mentioned under Suppuration
& formation of an abscess. When sanguineous effusion
takes place, the Patient falls into an apopletic
state, from which he never recovers.
If coagulable lymph is effused the Patient may
live for a number of years, but this kind of
effusion is very rare. If adhesion takes place the
person soon dies it being not at all compatible
with life, but this occurrence is likewise extremely 
infrequent. These are the sequels of inflam.n
the process of Resolution being the termination.
Appearances post mortem. We
find inf.n of the Dura Mater - Coagulated Lymph
within the Membranes & likewise Adhesion
Pus covering a part of Dura Mater which is
sometimes found eroded - Inf.n of the Pia Mater
adhesion between it & the membranes above
it - Inf.n of the substance of the Brain, but w.h
rarely happens but from external violence-

78
Abscess is occasionally found in the substance
of the Brain - Mortification - When the effusion
of coagulated lymph takes place, although it
does not destroy life, yet it perverts the operations
of the mind generally in a more or less degree 
producing sometimes idealism or Amentia &
at others madness or Mania, & thirdly where
the mental powers have been perverted, they
only continue to for a short period as a few
weeks or months & reappear again. In forming
our Diagnostic, we must observe the symptoms
described in the beginning of this treatise
which will very evidently distinguish this
Disease. Our Prognostic must be formed according
to the degree of violence in the symptoms
present & of the part w.h is effected.
This complaint is not only attended by immediate
but as we have found remote danger.
If Phrenitis comes on suddenly with great
violence, & the patient being of that state of body
favourable to it, he is generally cut off in four days.

79
The Proximate cause of Phrenitis is inf.n
of the Brain. The remote is divided into the
predisposing & exciting cause, the former as it
happens in early manhood & in youth - not
in a weak & debilitated constitution but those
of a full plethoric habit of body these have
been considered the predisposing causes, the
latter or exciting causes are those w.h tend to
increase the determination of blood to
the head, as violent exercise; exposure of the
head to a hot sun; some external violence;
causes that prevent the free return of blood
from the head. Treatment. In heating this 
complaint we must first consider the
general & local excitement, the former
being considered to proceed from the local
change; as there is an increased action
of the heart & arteries, our endeavour will 

80
be to diminish the volume of blood by
blood-letting - those that are of a plethoric
temperament, we must bleed copiously, as taking
20 oz at a full stream from a large orifice - but
the arm is not the only part where we may
bleed with advantage, as the temporal arteries
or external jugular vein - after venæsection
we must give a purgative as Infus
Senna C. ℥iij Magn. Sulph ℥j Ext. Colocynth. C. gr xx
the draught to be taken immediately if necessary
repeated in four hours in half a dose.
If the remedies w.h have been used have produced 
no effect, (that is) diminished the preternatural 
excitement, we must take 20 oz
more of blood & the above purgative given
in diminished doses every day - the patients
diet should correspond with the treatment
as allowing thin gruel, toast & water, barley
water &c only. You may now commence giving

81
him Diaphoretics as Lq. Ammon. Acet ℥ss Aq.
Distillat. ℥iss Lq. Ant. Tart gtt x ad xx every five hours
or Pulv Antimon. gr v every 6 hours. Medicines that
are calculated to produce nausea, have the
power of lessening the heart action by
producing such an effect on the stomach as
to excite the Brain thro' sympathy as Ant
Tart given in small doses. Cold applications
must be placed on the head as ice or
the head spunged with cold vinegar & water.
The repetition of the bleeding must be regulated
according to the violence of the
symptoms, & at short intervals also apply
cupping glasses to the head, warmth to the
lower extremities. Blisters are occasionally
used in this malady & applies to the
back, nape of the neck & lastly the head
or scalp, but seldom to the scalp as it prevents 
you from employing other remedies -

82
The Patient must be kept quite still
& quiet, the room darkened, w.h should be
a large & airy apartment with a free
current of air passing through it - the
external as well as internal senses of the Pelvis 
must be kept quite dormant - Be on your
gard for the critical symptoms occurring
& encourage them when they do occur, doing
nothing in your power to obstruct
it, as at that time to bleed or give purgatives -
if the symptoms decrease it will
indicate that the more violent remedies
must be left off or diminished & slight
Tonics as Bitter infusions given. If resolution
does not take place there generally
succeeds suppuration or mortification
here nothing can be done by the medical
attendant. If effusion occurs the danger
resulting from it will be according of it - 

83
if purulent it will be fatal, but if serous
then it will depend on the quantity effused
w.h if it should be small the patient may
recover by its being reabsorbed. If sanguineous
then it will depend on the magnitude
of the vessels ruptured. If coagulated lymph
this will either be followed by death or
disorder of the intellectual faculties
according to the guantity of lymph effused.
Genus X. Cynanche
Characterized by Pyrexia sometimes of the
ardent kind; redness & pain of the fauces;
deglutition & respiration difficult; with a
sense of tightness in the fauces. The species
are 1st. Cynanche Tonsillaris (ie) affecting
the membrane of the fauces particularly
the tonsils, with tumor & redness; accompanied
by Cynocha. 2nd. Cynanche Maligna

84
affecting the tonsils & mucous membrane
of the fauces, with swelling, redness; and
mucous crusts of a whitish colour or ash,
covering ulcers; with typhus fever and
eruptions. 3rd. Cynanche Trachealis: difficult
respiration; inspiration loud; voice
hoarse; cough sharp; hardly any apparent
swelling in the fauces, swallowing not very
difficult; with Synocha 4th Cynanche Pharyngea:
with redness chiefly at the bottom
of the fauces; swallowing exceedingly difficult
& painful; respiration easy: with
synocha. 5th. Cynanche Parotidea: with great
great external swelling of the parotid
& submaxillary glands; respiration & deglutition
little impeded, fever synocha
in general slow. The symptomatic diseases
of this genus arise from internal causes

85
& likewise from external causes - Cynanche
Tonsillaris, when a patient is first affected he
complains of a sense of tightness in the fauces,
his deglutition being painful, saliva increased,
heat of the body augmented, together
with dryness of the fauces - the pulse full
hard & frequent, urine high coloured, animal 
functions little impaired, bowels constipated,
thirst, exacerbations in the evening, sometimes
only one gland at others two is effected,
if the enlargement should be considerable
not only deglutition but respiration
also will be much impaired, & the
voice sometimes lost; a ropy saliva will be
spit from the mouth, with swelling of the
submaxillary glands, the eustachian tube
becomes inflamed producing deafness &
if the attack is very severe the face & cheeks
are swelled & florid, the neck stiff, hard, tumefied

86
tumefied & painful, the inf.n sometimes extending
to the membranes of the Brain - the inflammatory
stage seldom continue longer than
the 7th day generally only till the 4th ending
in Resolution & the signs of local & constitutional
symptoms disappear, but we seldom
expect to find a case of C. tonsillaris to end in
resolution, mostly in suppuration, an abscess
forming in the substance of the gland, bursts
& the matter is evacuated, when recovery will
rapidly take place. You may know when suppuration
is going to take place by the febrile
symptoms intermitting, the pains being larcinating,
& the swelling at the same time
increasing, the suppurative process does not
continue longer than 24 or 36 hours, if beyond
this time it is customary to open it with
a lancet. This complaint seldom ends in
mortification, but when it does the parts

87
become flaccid & of a livid colour, pulse weak
tremulous & irregular, breath very fetid, with
no pain in the part; great anxiety is expressed
by the patient. Another termination of this
disease is in induration occasioned by coagulated
lymph being effused into the cellular
texture composing the tumour & not reabsorbed
w.h you may distinguish by all the symptoms
disappearing or abating yet the glands remaining
swelled. The Proximate cause is infer the
remote is divided into predisposing & exciting
causes, the former as it is more apt to occur
in the Spring than Autumn, & persons who
are of a habit of body favourable to inflammatory
disease will be more liable to be effected
with this complaint than a person who
never has had it & if a different temperament
the Exciting - as cold & moisture, sudden vicissitudes
of temperature, suppressed eruptions
or any evacuations as perspiration suddenly stops

88
The Diagnosis will not here be difficult
being a part under the observance of our
external senses, it is accompanied by the
inflammatory fever as symptomatic. There
is seldom any danger to be apprehended
from this complaint although it sometimes
happens that the greatness of the
swelling in the fauces will suspend respiration,
but it is a very rare occurrence.
What often retards the cure is that
no sooner is one tonsil healed than the other 
is effected - Treatment - I must first remark
that whenever any part which
is necessary to life is effected with inflammation
we must employ the most
active means, but where this is not the
case, less active treatment will suffice -
Therefore when the symptoms in this disease

89
disease are moderate (that is no febrilo action
of any consequence existing) bleeding
will not be necessary, but give in the first
place an emetic composed of Pulv Ipecac
gr xv Ant gr I vel Pulv Ipecac 2j vel Ant Tart gr i
afterwards a purgative as the common Black
Draught or Magn. Sulph ℥j Infus. Senna 
℥ij ter horis si opus sit. If the symptoms & excitement
be greater then take away ℥xvj
of Blood from the area or jugular vein
after the Patient has been thus treated Diaphoretics
will be exceedingly proper as
Lq. Ammon Acet ℥ss cm Mist Camph ℥iss Lq.
Ant. gtt x. The diet must accord with the 
general treatment. The Bleeding to be repeated
if necessary. Calo gargles may
be used as Ice-water or Lq. Plumb. Ant-Dil
the throat must be frequently wash
or these gargles will have no effect -

90
External remedies must likewise be
resorted too as Spt. Ammoniæ Blisters -
Mustard poultices & it is possible that the
external inf.n w.h will be excited by the above
remedies will remove the internal disease
If critical symptoms take place you must
encourage them. If suppuration occurs
then some of your applications must be
changed as for instance it would be improper
to use cold Gargles therefore warm 
ones must be substituted composed of
Barley water or thin Gruel, warm poultices
to be applied externally; the pus
usually discharged is generally of a very
healthful character; if from the enlargement
of the swelling life is endangered
it would be advisable to introduce into
the larynx a flexible gum tube, if this

91
could not be done, we must resort to
Tracheotomy. If those unfavourable symptoms
should take place, w.h announce mortification,
it will be necessary to give Bark & Muriatic 
Acid after the same manner as mentioned
under the head of Typhous fever &
the other remedies must be discontinued.
If induration takes place Sir G. Tuthill says
he knows of no remedy w.h we possess that
will be able to relieve the Patient, except
by Operation (ie) by ligature removing the tonsil
glands. Of Cynanche Trachealis or Croup
this complaint is incident to children, the
respiration is performed with a wheezing
noise, cough sonorous, deglutition unimpeded,
without appearance of any tumour
in the fauces; it is a very acute disease
after terminating life with extraordinary
rapidity; it consists of inf.n lining the
mucous membrane of the fauces & Trachea

92
It presents two sets of symptoms constitutional
& local, the former being regarded as
symptomatic of the latter. The child at
first complains of pain & uneasiness in
the larynx after w.h there is an increase of
heat, urine high coloured, the secretions diminished,
great thirst & restlessness, inspiration
performed with a wheezing noise,
the voice becoming shrill, & coma sometimes 
supervenes. The wheezing noise is
dependant on spasmodic action. It is a 
very fatal disorder notwithstanding the most
approved modes of treatment have been resorted
too. Half the children who are attacked
with this order die of it; suffocation being
the cause. The favourable symptoms are, a great
diaphoresis taking place, a plentiful secretion
of urine, & a copious & free expectoration
of mucous - these occurence favourable term.n
together with an eruption of red blotches over 

93
the surface of the body; but when breathing 
is performed with more difficulty, the pulse
becoming weak; & the countenance bloated,
no remedies will be able to save the patient.
The causes are divided into remote & proximate
this last is inf.n the former is unknown - Exciting
causes are application of cold, occurring
more frequently in Winter & Spring &
likewise when there is change of the Atmoshere
from hot to cold. Treatment. Our
object here will be to diminish the volume
of blood; recollecting that the disorder proceeds
with great rapidity, therefore the remedies
resorted too must be of such a nature
as to act immediately on the frame & not to
employ any remedies w.h do not produce
some effect in a few hours. If the child is
2 years old take 4 or even ℥vj of blood from the
arm, then give an emetic of Ant. Tart gr I, &
after the operation of which the bowels must

94
be moved freely by giving of Hyd. Sub. Mus
gr iij ad iv cm Inf. Peruna ℥ss every half hour
untill it procures eight or nine stools. We
should visit our patient again in three hours
& if we find the inflammatory action is
not diminished blood must be again
taken from the arm or jugular vein, with
cupping & leeches applied in the course
of the trachea, blisters externally, likewise
Mustard Poultics, the latter to be 
preferred to the Blisters; give also Diaphoretics
as Pulv. Ant. & Keep up the action of the 
bowels by gr of Calomel regulating the dose,
according to the age & temperament of the
Patient & violence of the symptoms, at short
intervals. This plan of treatment is to be 
persisted in during the whole course of the
inf.n continuing; our object being being to
prevent the effusion of coagulable lymph 
w.h in the end will produce suffocation.

95
Inhaling the steam of hot water or combined 
with vinegar will sometimes do good.
When infer has produced this morbid secretion &
respiration continues to be performed laboriously
some Authors say the Operation of Tracheotomy
must be resorted too, but Sir G Tuthill
is of a different opinion, as he says the
impeded respiration does not depend on the
closure of the larynx by coagulable lymph
for the secretion, says he, falls down into the
Bronchia stopping it up thereby producing
those symptoms above mentioned. If critical
symptoms arise they must be encouraged.
The Diet must be simple; the less nourishment 
taken the better. Cynanche
Parotidea or Mumps. The symptoms
may be divided as the preceding diseases
into local & constitutional. It generally
comes on with uneasiness towards evening,
& the patient complains of stiffness in

96
the neck & when she awakes in the
morning, finds the parts much swelled;
the pulse is strong, hard, and frequent
attended with a mild Synocha. This complaint
generally lasts from 4 to 7 days.
A swelling of the breasts in women & of
the testicles in men, often accompany
or arise during this disorder; likewise
the Parotid & submaxillary glands inflame
& swell. It generally terminates in Resolution.
Your prognostic is always
favourable, & Diagnosis very easy. The
proximate cause is inf.n of the Parotid &
submaxillary Glands. Persons who have
had an attack of this disease are more
liable to it than others. It attacks generally
the young & robust; also excited
by the application of cold; some have
considered it as infections. Treatment

97
this is very simple owing to its not
being a dangerous complaint. Venæsection
will be here unnecessary; saline purgatives
& diaphoretics are in general sufficient
with a vegetable diet; frequently 
purgatives will suffice. If the breasts or 
testicles should swell, fomentations must
be applied; if the glandular swellings
should suddenly subside & delirium supervene,
(which is a very rare occurrence) -
Warmth must be applied to the effected
part. Cynanche Pharyngea - this
complaint does not require a seperate
distinction, being nearly allied to C. Tonsillaris
& the treatment being the same
the only possible distinction between
the two being that the inf.n in the
former being lower than the latter -
An emetic may be given at first combined
with a purgative as Potass. Tart. ʒij Ant
Tart gr I Inf. Sennae. ℥iss #. this sometimes stops its
further progress -

98
Pneumonia. Genus XI
Pyrexia; pain in some part of the thorax;
respiration difficult and cough -
The species are Peripneumonia, characterized,
by the pulse being not always
hard but sometimes soft; dull pain
in the breast; respiration always difficult,
and except in an erect posture
of the body, sometimes impossible;
the face swollen & of a purple colour;
cough, in general moist, after bloody.
1st. Simple & Idiopathic. 2nd. Idiopathic
with fever 3rd. Symptomatic. Pleuritis
is Known by the pulse being hard;
pain in general of the right side, pungent,
& increased especially at inspiration;
lying on the side troublesome;
very painful cough, at first dry, afterwards

99
afterwards humid; & after bloody - 1st. Simple
& Idiopathic. 2nd. Complicated. a. with fever
B. with Catarrh. 3rd. Symptomatic 4th. False
Pneumonia ends in Vomica. after Pneumonia
not terminating in resolution; constant
difficult respiration and cough
uneasiness on lying on the round side; with
Hectic fever. Empyema. After pneumonia,
ending in suppuration, often after
vomica, a remission of pain; while the difficult
respiration, cough, pain on lying 
on the side, & hectic fever remain; often
accompanied with or sense of fluid in
the breast; & with symptoms of hydrothorax.
Pneumonia, before describing
the symptoms says Sir Geo. Tuthill
I must remind you, that all circumscribed
cavities are lined by a serous
membrane, as the Pleura for instance,
of w.h there are two, one for the right, the
other for the left side of the chest, forming

100
forming different processes w.h cover the ribs,
lungs, diaphragm & pericardium. The two
Pleura meet & form a triangular space
between them, which is called the Mediastinum;
this is liable to inf.n. The Lungs
are situated on each side of this partition,
the right divided into three lobes
the left into two, the whole of w.h is covered
by the Pleura. All the blood w.h passes
through the body, circulates thro' the lungs.
The Trachea is divided into what are called
the Bronchia, & these terminate in
the air-cells. The substance of the lungs
is parenchymatous. If Inf.n attacks any
of the parts above mentioned, it goes
under the name of Pneumonia, w.h
is known by pain in some part of the
chest, difficult breathing, cough & fever
& is divided into two species Peripneumoia
& Pleuritis, it is called the former 

101
when the substance of the lungs is inflamed,
the latter when the Pleura is
effected - in this manner have they been
disseminated from each other, but the
symptoms differ only in some cases, and
Morgagni relates, that he dissected the
body of a person, who was supposed by
his Physicians to have died of Peripneumonia,
but when he inspected the
thorax he found only the Pleura affected.
The symptoms by which we generally
distinguish Peripneumonia from Pleuritis
are the following, in the former the
pulse is not hard but soft when compared
with the state of it in Pleuritis,
the pain obtuse, constant difficulty of
of respiration, & often unabled to perform
which unless the body be in an
erect position, the face bloated, and 
often of a blueish colour, cough very severe

102
accompanied by an expectoration of 
mucous, sometimes streaked with blood -
A contrary set of symptoms distinguish
Pleuritis, which is thus defined, pulse
hard & frequent, pain in the right or
left side, very pungent & increased on
pressure and on inspiration, cough, unable 
to lie on the side, the cough being 
at first dry, then moist and afterwards
bloody. Dr. Cullen declares says Sir Geoe
that our diagnostic symptoms will not
enable us to pronounce whether it is
the substance of the lungs or the Pleura
w.h is effected. There are two sets of symptoms
prevailing in this disease constitutional 
and local, the former being
regarded as symptomatic of the latter.
The patient at first complains of a
sense of tightness & weight in the chest,
a slight difficulty of breathing, & a little

103
short dry cough, these symptoms as the
disease advances gradually increase accompanied 
by chilliness & a sensation of a cold, 
& after a time followed by increased temperature
of the body, & frequency of the
pulse, thirst, the breathing becoming
anxious & humid; a mild attack will
present only the symptoms above enumerated;
but the attack should be severe
then all these symptoms will be greatly
increased, & vary in different cases as the
pain being increased more in inspiration,
likewise the difficulty of breathing,
& being situated in different parts of 
the chest, tho' generally between the sixth
or seventh rib or under the sternum.
A cough is the constant attendant of
diseases of the chest, being sometimes
dry, others moist, & the mucous expectorated
frothy & of an ash colour, at other

104
times thicker being of an yellowish or
greenish colour, & sometimes red with blood
the secretions diminished, bowels constipated,
thirst, the tongue the same
as in inflammatory fever, the skin dry
& urine scanty; it generally continues
to the 7th. 14th. or 21st day at the expiration
of w.h it may be resolved, & if resolution
does take place it will be marked by 
some critical symptom as a copious & 
free expectoration of mucous, profuse &
universal perspiration, hemorrhage from
the nose, a copious secretion of a lateritious
sediment in the urine, diarrhœa
&c, if any one or more of these symptoms
occur on the 4th. 7th. or 14th day of the
disorder, w.h at the same time remits,
we may expect resolution, but if the
inf.y stage lasts longer than 14 days, then 

105
some other effect will take place more
unfavourable, w.h will be known by the
Patient being seized with a shivering &
partial sweats, with a remission of the pain,
the cough, & difficulty of the breathing still
continuing with exacerbations of fever in
the evening, these symptoms denote that
suppuration has taken place, denominated
by Dr. Cullen Vomica, with a difficulty
of lying on the sound side & hectic
fever, w.h I will now explain to you, it being
symptomatic of this & other fevers; it depends
of local disease, more commonly attacking
scrofulous habits effected with inf.y diseases.
There are two exacerbations daily, the
greatest being at 5 o clock mane; the Patient
feels a slight chilliness & complains
of a sense of cold, when to another his skin
feels warm, his pulse is from 110 to 140;
about 2 p.m. a remission takes place

106
w.h lasts till 5; the next afternoon the
noon exacerbation can scarsely be preserved,
profuse night sweats; urine depositing
a lateritious sediment; the tongue moist
& preternaturally red at the commencement;
bowels constipated, but towards
the last a diarrhea. The weakness now
becomes excessive; in women the menstrual
discharge ceases; the legs become
œdematous; the spirits not oppressed 
& in general good; the functions of the
abdominal viscera not much altered;
the mind confident to the last; this
fever commonly follows abscess or vomica
in the lungs, w.h if they should burst
in the Bronchia may possibly be expectorated,
but sometimes may suffocate
the patient; if they do not burst Phthisis
Pulmonalis will be produced, and the

107
constant formation of matter, with
Hectic fever at last destroys the Patient
tho' slowly; he may die from excessive excitment 
before the vomica bursts, w.h if
it should do into the chest, will be known
by the remission of pain, while the other
symptoms continue, & a fluctuation will
be perceived - the case is now hopeless -
Adhesion may form between the Pleura
Pulmonalis & Costalis, but if this should
not occur, mortification may very soon
prove fatal. The serous vessels of the
Pleura may take on a diseased action
& produce pus (ie) secrete it, or fibrin
may be extravasated. The attendant fever
is Synocha at first, & latterly Hectic -
extensive visceral disease is rare. The
diagnostic is easy, & as to the prognostic
if the symptoms are mild it is favourable.
A serous effusion occuring is highly 

108
dangerous. Persons between 45 & 60 are
particularly liable to it; sudden exposure
to cold so violent exercise are excitants
to its formation, as well as inhaling of
noxious vapours. Treatment. We commence 
by taking 20 to 25 ounces of blood
then give a cathartic of Inf. Sennæ ℥ij
Magn. Sulph ℥i after the bowels have 
been briskly moved, small doses of the
aperient must be given thro' the complaint.
If the symptoms do not abate
in four hours after using the above remedies,
take another pint of blood. Blood
should be drawn early in these diseases
& from a large orifice; diaphoretics may
also be prescribed, & cupping on the Chest,
a blister to be applied to the part affected;
promoting at the same time expectoration 
by the following Acetum Scillæ
℥ss added to a diaphoretic draught. If the

109
cough is severe & dry, mucilaginous &
saccharine mixtures are to be given; and
to diminish the irritability about the
fauces we may employ common syrup, slightly
acidulated or equal parts of Syrup &
mucilage with a little Oxy. Scillæ, also
an electuary of Conf. Rosæ. C. - taking care
not to give any medicines w.h would counteract
the critical symptoms if they should
occur. The diet should consist of their gruel,
barley water, toast & water &c, and by degrees
as the Patient gets better, the Gruel must
be made thicker, & to be allowed light puddings;
take care to obviate constipation as
it is liable to reproduce the inf.n Digitalis
has been employed to moderate the
action of the Heart & arteries but says
Sir Geo.e I have seldom seen it produce
much good effect. The apartment in Winter
should be kept at 60 dg. with a small fire -

110
When an abscess forms & points externally
it should be opened with lancet, but
if it bursts between the Pleura, the operation
of Parencentesis Thoracicum has been proposed,
but it is scarsely ever performed, no
good effect (in general) resulting from it
& the wound being difficult to heal,
also it is not easy to determine wether
it is water or pus that is contained. If the
disease should terminate in Hydrothorax
or serous effusion, it then constitutes a
complaint of the Dropsical Kind, which
will be treated off in its place. If mortification
occurs, then nothing can be done
to save the Patient; stimuli may arouse 
him for a short period, but death inevitably
ensues - a most dangerous symptom
is when weakness prevails without 
expectoration, in w.h case wine must be 

111
given to prevent suffocation. If adhesion
should take place, there will be no particular
symptoms w.h indiciate such a termination;
such a state is not incompatible
with life - It is necessary that, the
diseases of this order, should be treated in
a bold & decisive manner at their commencement.
Hippocrates & Areteus divided 
& heated this disease nearly in the
same way as Cullen has done - Hippocrates 
considering the mucous being streaked
with blood as not an unfavourable
symptom, Areteus on the contrary thought
it very unfavourable -
Genus XII. Carditis Cullen -
Pain in the region of the heart; Pyrexia;
anxiety; difficult respiration; cough;
unequal pulse; palpitation; & syncope in
1st. Idiopathic. 2nd. Symptomatic - 

112
Cullen, Linneus, and Vogel have
each considered Carditis & Pnenumonia
as one disease; but notwithstanding these
high authorities says Sir G. Tuthill it is
my opinion that the symptoms which
present themselves are sufficient to make
a marked distinction. If the malady is
mild, if generally resolved in about 7 days.
An abscess rarely forms, but adhesions
to the sides of the chest may take place,
or mortification. If effusion should occur
it constitutes the disease called Hydrops
Pericardii. Carditis is a dangerous and
frequently fatal disease, owing to their being
a vital organ concerned, & that the
centre of the circulation. Treatment -
This like Pneumonia is to be cured only
by evacuants. If the symptoms are
severe blood must be taken from the

113
arm untill it produces deliquium,
afterwards a purgative as the Black draught
to be given - Our endeavour here must be
to effect a resolution, as this may be considered
to be the only favourable termination
of this disease - therefore we must
repeat the evacuations at short intervals
again & again untill the violence of
the symptoms abate. The skin being
in general dry, saline diaphoretics
will be useful gives every four hours -
Cupping & leeches applied to the region
of the heart will have a good effect when
the pain is severe; we may also give expectorants
as Oxymel. Scillæ &c. Dr. Tuthill
does not approve of digitalis being taken
in this complaint, & likewise animal food
while the inf.n diathesis prevails. If an
abscess should form, & burst into the auricles
or ventricles, the matter mixes with the

114
blood producing instantanous death,
but if on the contrary the abscess bursts into
the Pericardium, death will ensue, gradually
accompanied, or more properly speaking
preceded by a great degree of emaciation,
& its progress towards that event will be
slower - If the abscess in consequence if its
adhesion to the ribs, should point externally,
then it must be opened with a lancet.
When mortification or Hydrops Pericardii 
occur, they quickly destroy the Patient.
This is a complaint w.h quickly
runs its course. If it is not resolved in
7 days our prognosis will be unfavourable
Genus XIII. Peritonitis. Cullen -
Pyrexia; pain in the abdomen; increased
when the body is erect; but without
the symptoms peculiar to other abdominal
inflammations. 1st. Peritonitis Propria,
in the Peritoneum. 2nd. Peritonitis Omentitis

115
in the Omentum. 3rd. Peritonitis Mesenterica,
in the Mesentery. Treatment. We
must commence our curative means by
taking ℥xvj of blood from the arm, & giving
purgatives every hour untill they operate,
venæsection should again be resorted too if
requisite in four hours; also employing
Diaphoretics & applying a Blister to the
anterior surface of the Abdomen. The warm
Bath at 96 deg., or warm fomentations to the
part effected will be serviceable. Leeches
or cupping will moderate the local symptoms.
Slight sedatives as Ext. Hyosciaim 
& cooling Glysters may be given. If the
action of the heat should decrease under
this mode of treatment, but the pain
continues, the remedies must be persevered
in. Dr. Tuthill prefers the use of purgatives
& diaphoretics. If mortification
or suppuration ensues the Patient is lost
if serous effusion takes place, it will be 

116
heated off hereafter under the head of
Ascites.
Genus XIV. Gastritis.
Cullen. Pyrexia, of the Typhus kind, anxiety;
excessive heat & pain in the epigastrium,
increased by anything taken into
the stomach; inclination to vomit, and
the ingesta immediately thrown out: hiccup.
1st. Idiopathic. a. from internal causes. 1st
Gastritis Phlegmonodea, with acute pain
& vehement Pyrexia. b. from external causes
2nd. Gastritis Erythematica, with slight
pain & fever; & erysipelatous redness of
the fauces. 2nd. Symptomatic. Before
Describing this disease, we must consider
that the Stomach is situated in the Epigastic,
& partly in the left Hypocondriac
region, having two orifices a Cardiac and
a Pyloric, the former being the termination 
of the Asophagus, the latter the 

117
commencement of the Duodenum; it
has four coats, viz, a Peritoneal, Nervous,
Muscular, and villous. The pain will always
point out this disease. The pulse is
small & weak but frequent; great prostration 
of strength. The distinguishing symptoms
between Gastritis P. & Gastritis. E.
are very obscure. As in other diseases of this
order there are two sets of symptoms local
& constitutional. It commences by the
Patient complaining of uneasiness at the
stomach, the contents of which is ejected
attended with a troublesome hiccup. The
pulse is small, hard & irregular; thirst
great; countenance anxious; great depression
of spirits; the tongue dry & covered with
a brown crust; respiration as the malady 
advances becomes difficult & interrupted;
coldness of the extremities; violent hiccup
&c terminate his sufferings. Resolution
is the only favourable termination, & is 

118
generally announced by some critical symptom
occurring about the 7th day, & recovery
soon following; but if on the contrary the
symptoms of inf.n continue longer than the
7th day, suppuration is to be feared. An
abscess may form between the coats, & its presence
detected by the absence almost of
pain, & the presence of Hectic Fever. If it
bursts into the alimentary passage, the
matter may be evacuated per anum &
the opening heal. Mortification is to be
dreaded if the pain should entirely cease,
with a cadaverous appearance of the countenance,
coldness of the body &c. Death
in this case is certain. In our Diagnosis
we must not confound it with Cramp,
it being distinguished from this malady
by the presence of Pyrexia, depression of
strength & considerable derangement of
functions. Gastritis is a very dangerous

119
disease. The causes are the same as those
of the other diseases under the Crou Phlegmasiæ,
& except where it arises from the
specific action of poisons. Post Mortem the
coats of the stomach will be found thickened,
the inner membrane will be red
& covered with spots of extravasated blood;
either fibrin or pus is found secreted.
Treatment. It was formerly thought, from
the Weak state of the Hearts action, that
Bleeding was inapplicable; but now it
is well known that this depends on the
sympathy existing between the Heart & 
Brain, and the diminution of nervous
energy, & that by abstracting blood freely
you lessen the inf.n & irritability of the 
stomach, & thereby remove the vomiting.
If medicines cannot be taken by the mouth,
clysters must be given; the warmth bath
used, and if the symptoms do not abate
in 5 or 6 hours, more blood must be taken.

120
Venæsection is our chief remedy, as it
diminishes the volume of circulating blood,
& has the remarkable property of staying
the vomiting; also a blister applied to the
Stomach. Calomel in the dose of gr v will
sometimes stay on the stomach when
other purgatives fail to do so. The prostration
of the strength, (so very evident) being
the reason why the Pyrexia present is called
by Dr. Cullen of the Typhoid type, is generally
removed by early depletion. When
Diaphoretic & Purgative medicines will
stay on the stomach, they ought to be
given, of the former the effervescing Draught,
Cupping or leeches applied locally maybe
useful, & a low vegetable diet. In abscess
or suppuration medicines are totally useless,
& if life is preserved after the occurrence
of the above, it is by the favourable
situation of the tumour.

121
Genus. XV. Enteritis. Cullen -
Fever of the typhous kind, sharp pain in
the abdomen, spreading & twisting about
the umbilicus; vomiting, and obstinate
costiveness. 1st. Idiopethic. a. Enteritis Phlegmonodea,
with acute pain; vehement
pyrexia, vomiting, & costiveness. b. Enteritis
Erythematica, with slight pain & fever;
without vomiting & with diarrhœa. 2nd.
Symptomatic. This complaint has local
& constitutional symptoms. The pain is
described as twisting, & is concentrated
about the part; tumefaction is frequently
present; feculent matter is sometimes
ejected by vomiting. When the disease is
seated in the Duodenum, there will be
a greater diminution of the action of the
Heart, then when its seat is in the colon.
It is a complaint w.h quickly forms, & may
as in Gastritis destroy the Patient during 

122
the inflammatory stage. Resolution is
generally announced by a moderate diarrhœa,
or if the inflamed portion is low, bleeding
from the hæmorrhoid veins, & an increased
flow of urine or perspiration. If after the
7th day rigors come on with & diminution
of pain, & a sense of weight in the part,
then an abscess or suppuration may be
be expected, but if after the inf.n has been
very severe, the pain should suddenly subside,
mortification will ensue, tho' the
poor Patient thinks he is recovering. In
these last mentioned cases nothing can be
done, but it must be left to Nature. Syncope
is a troublesome symptom in this
complaint. When we are called to a Patient
labouring under what we call enteritis, we should
be careful to find out if the Patient
has an Hernia; for if so, the treatment may
be directed accordingly. Treatment - 

123
It consists in taking at the commencement
from a large orifice about 20 or 
30 3. of blood from the arm, afterwards to
give a purgative of Castor oil 3ji; but
when these exists so great an irritability
of the stomach, that medicines cannot
be retained; Glysters may be given with
advantage containing some of the Ol.
Ricini; the warm bath at 100 dg. as warm
fomentations will sometimes afford
considerable relief when applied to the
part effected; Diaphoretics & local bleeding
will also be proper; the bowels must be
carefully attended too, being kept constantly
relaxed.
Genus. XVI. Hepatitis. Cullen
Pyrexia; tension & pain of the right
hypocondrium; sometimes pungent as in
Pleuritis, but oftener dull; pain at the 

124
clavicle & top of the right shoulder;
pain in lying on the left side; difficult
respiration; dry cough; vomiting; hiccup.
1st. Acute: known by the above marks
2nd. Chronic: Often affording no signs of distinction.
The symptoms in this disease
says Sir G. Tuthill vary according to the
situation of the inf.n, the pain being
more pungent when seated superficially,
and more obtuse when deep -
The complaint begins with uneasiness
soon accounting to pain in the left
side; the urine is high coloured; the
bile being obstructed mixes with the
circulating fluids, tinging the countenance,
& the Tunica Conjunctiva
of a yellow colour; occasionally delirium
is present, with tumefaction of the abdomen
& constipation, tho' sometimes a diarrhœa

125
occurs, dependant either on the deficiency
or superabundance of the secretion
of bile. It usually terminates on
the 7th day, accompanied by some critical
evacuations, it is then said to be
resolved. If suppuration should take
place, & an abscess form, bursting into
the cavity of the abdomen, it will soon 
destroy life. It may burst in different
ways, as from adhesion, into the intestinal
canal, into the biliary ducts,
or through the Diaphragm & Pleura into
the Bronchia, in which last termination,
the matter will be expectorated, 
& the Patient may possibly recover.
This complaint terminates either
in resolution, adhesion, induration, enlargement
of the liver, suppuration
& lastly mortification. The liver is particularly

126
particularly liable to suppuration &
chronic inf.n Acute inf.n of the liver
may exist without all the symptoms,
w.h I have enumerated, being present
for instance, if the concave portion
of the liver is inflamed, it being so remote
from the Diaphragm, the cough
& difficulty of breathing will not be
so severe & less evident to be discerned,
but sickness & vomiting will be more
prevalent, in consequence of its vicinity
to the stomach; which sympathizes
most readily - If the parenchymatous 
substance be effected the pain
will be sharp, but if the peritoneal
coat of the viscus is inflamed, the pain
will be extreme in the shoulder,
clavicle & stomach, being also severer

127
during respiration. When the upper surface
of the viscus is effected, it will be attended
with a dry cough & hiccup; the pulse
will be large & strong, beating from 
110 to 120; the skin hot, with an effusion
of bile, & consequently jaundice;
delirium & tumefaction of the liver,
constipation of the bowels. If resolution
should take place it will be on the
7th day followed either by Hemorrhage.
a biliary diarrhœa, profuse perspiration,
copious expectoration, an abundant
flow of urine or a cutaneous
eruption. If suppuration occurs it will 
be indicated by a clammy skin, cold
extremities, with occasional warm
flushings & hectic fever. Mortification
rarely occurs. Hepatitis may be produced
by biliary calculi or hydatids in the 

128
liver; the colour of the calculi is commonly
brown, but may be whitish or
greenish, when cut into they will often be
found compact & firm, and sometimes
laminated & radiated in the centre;
differ in size & number, the largest says
Dr. Tuthill which I ever saw, was of the
size of an hens egg. Dr. Hunter had in
his collection, w.h is now at Glascow, a
gall bladder, containing upwards of
one thousand gall-stones. These produce
inf.n by mechanical irritation. Hydatids.
are contained in a cyst, which is
of a texture resembling cartilage, every
hydatid having a seperate cyst, in which
they swim in a liquor; some have supposed 
that these possess life, & in the
sheep their motion is perceptible, though
not in the human subject, which may

129 
be owing to the length time which generally
elapses before the body is examined, 
the principal of life in these animals
being then extinct. In sheep also their 
organization is more perfect, having a
head & neck attached to a bag, but when
found in the Brain of a sheep they resemble
those discovered in the human subject.
When the inf.n extends through the
Diaphragm to the Lungs, which sometimes
is the case, hydatids have been
known to have been expectorated in
considerable quantities. The liver in
some cases of suppuration has been a
mere bag containing pus - Treatment
Our indications of cure will be the
same as in other diseases of this Order,
with some modifications, for tho' this
complaint should be equally violent

130 
yet we must not bleed to the same
extent & frequency, taking about ℥xvj &
giving directly after a saline or mercurial 
purgative or both, then diaphoretics;
cupping or leeches may be applied
locally, where venæsection a second
time is unnessary, above which it is
seldom warrantable to bleed. If the vomiting
is troublesome an effervescing
draught may be given; if a dry cough
expectorants; if restless opiates. Nourishing
but mild diet must be given
during the formation of an abscess, &
after it has burst, supposing it to do
so externally - in order to support the
Patients strength, & mercury is recommended
during the decline of the
disease, to prevent induration, enlargement,
or chronic hepatitis -

131 
Chronic Hepatitis. This affection
shows no local symptoms, by which we
are able to distinguish it, but I am persuaded
says Sir George that the constitutional
derangement will always
point it out; the diminished action of
the liver being very remarkable. This
complaint is perpetually mistaken
for Dyspepsia. There is commonly uneasiness
at the stomach, & tenderness
about the region of the liver on pressure,
digestion is badly performed; an obtuse
pain at the Scrobiculus Cordis & right
Hyprocondriac region, with increased heat;
acidity of the stomach; sleep unrefreshing;
temper very irritable; the bowels irregular,
stools varying in appearance; the pulse
feeble; urine scanty; tongue foul; slight
cough with evening exacerbations of fever
& night sweats. The disease may continue

132 
for weeks or months, and then terminate
in resolution or abscess. The danger
in this last is the same as in acute
Hepatitis, with the same chance of its
pointing externally. This form of Hepatitis
is not so dangerous as the acute,
the former occurring generally in an exhausted
& indolent constitution, the
latter in a sanguine habit. The liver
undergoes commonly a change in shape
& consistence, especially the left lobe.
Although there is an increased vascularity;
yet blood-letting is not necessary
to any extent; sometimes the complaint
takes the middle course between
the two forms; so that you can
hardly distinguish, wether it takes the
acute or chronic form. At its commencement,
(ie) when we are called in, we

133
give a purgative as Pulv. Rhœi 2j Calomel
gr vj & the Pil. Hyd. gr v omni nocte et mane 
when the Mercury has produced a slight
effect on the system, it must either be
diminished in proportion, or given at
longer intervals, keeping up the effect
for six weeks. Or we may rub in of Ung
Hyd. F. ℥j on the region of the liver - There
are cases w.h mercury does not cure in
slight doses, but if given till salivation
is produced, then it has a favourable effect.
Hyoscimus, barium & Taraxacum
have each been recommended, or the
Carbon. Soda gr x vel xv cm. Taraxacum.
Effervescing draughts must be given
if sickness should occur. This disease is
very fatal to Europeans in India from
some peculiarity in the Climate, not
from the Temperature. Cheltenham has
been recommended to persons returning

134 
from the East, affected with this complaint.
Sir G. Tuthill thinks they would
recover as well in any part of Europe
as at this celebrated place, tho' he says
the waters may have the effect of doing
a little good from their aperient qualities
the practice in India is to procure
salivation quickly by giving large 
doses of Mercury, w.h we should not think
of doing in this Country -
The form of Hepatitis mentioned by the
Greek writers, as Hippocrates, is the acute 
w.h seems to have been most prevalent in Greece.
Genus XVII. Splenitis. Cullen.
Pyrexia: tension, heat, tumour & pain in
the left hypocondrium, increased by
pressure; without signs of Nephritis.
We will say Sir Geo. Tuthill first describe

135 
the Spleen - this viscus is situated in the
left hypocordriac region, between the
great extremity of the stomach, & the
neighbouring false ribs, under the edge of the
Diaphragm, & above the left Kidney, to all
of which it is connected by peritoneum.
It is of an oval figure; its external surface
is greatly convex; its internal surface
irregularly concave, and divided by
a longitudinal fissure, into w.h its vessels
enter; it is supplied with blood from the
Cæliac artery, which blood is returned by
the Vena Portæ; its nerves are from the
solar plexus; its structure is parenchymatous
& covered by peritoneum; it has
no excretory duct; the use of this viscus
has not as yet been ascertained. Inf.n
of this organ occurs in two forms, Acute
& Chronic; the former having two
sets of symptoms local & constitutional.
It commences with uneasiness & heat in

136 
the region of the Spleen, which gradually
increasing, amounts at last to pain,
which is increased on pressure, the symptoms
continuing to proceed, the Patient is effected
with chilliness, increased heat & frequency
of the Pulse &c. marking symptomatic pyrexia,
the different secretions from the 
blood are lessened; the skin is dry, with
thirst; urine high coloured; costiveness -
the inf.n symptoms generally proceed to the
7th or 14th day, when resolution may occur,
being announced by some critical evacuation 
as Diarrhœa; copious perspiration;
abundant secretion of urine depositing
a lateritious sediment if on
the contrary the inf.n symptoms become
more severe, & continue larger than the
seventh or 14th day, Suppuration will take
place, which will be known by the Patient
complaining of cold & shivering, with a remarkable

137
exacubation of fever towards
evening, with a remission of pain. If an
abscess should form, & burst into the cavity
of the abdomen, the Patient will die on
the 3rd or 4th day after the occurrence from
Peritoneal inf.n; but splenitis may terminate
in effusion of coagulable lymph, causing
adhesion, in consequence of which
the abscess points externally, & the Patient
may do well. It may burst into the 
stomach, & the matter expectorated or vomited,
or it will pass thro' the alimentary
canal, but effectually destroy your
Patient. It may burst into the Splenic
flexure of the Colon & the pus evacuated
M. arium, this generally causes death,
but the person may recover. Mortifica
seldom ensues, unless the disease is brought
or from external violence or injury as wounds.
Another termination is Chronic Splenitis
& permanent induration. It is liable to

138
all the effects w.h may result from
Acute Hepatitis. Your Prognosis will always
be favourable if the symptoms are
not very severe. As for your Diagnosis
you must refer to Dr. Cullen's description.
The causes are the Remote & Proximate -
Treatment. this must commence by
diminishing the column of blood from 
the Heart, & from the part effected, by taking
℥xvj of blood from the arm, & afterwards to
give a Calomel purge as Hyd. Sub gr vj Pulv
Rhæi 2j. to be worked off with the common
black draught; the bleeding must
be removed if necessary, & the bowels kept
regularly open Leeches, Cupping & Blisters
may be applied to the region of the Spleen.
the Diet must correspond with the general
treatment. If critical symptoms
arise, you will be careful not to check
them. As the Patient returns to convalescence

139 
his diet must be made more
nutritive. If suppuration takes place
little can be done, except the abscess points
externally, when let warm [cross out] formentations be
applied, & the lancet used during the
suppurative process the Patients strength
is to be supported - Chronic Splenitis
this is a Disease which advances very
slowly, & commonly unperceived by the
Patient; the first thing which he complains
off is a sense of weight in the
left side, when he is induced to take
medical advice - feels no pain in the
Spleen, but on examination it is formd
to have increased considerably in magnitude,
extending part the Liver Alba
even to the right side; it must be
evident therefore, that the functions of 
the abdominal viscera must be greatly
disturbed & inpaired in consequence of 

140 
pressure; inducing dyspeptic symptoms
costiveness; the appetite very much impaired;
also giving rise to dropsical
diseases, from the vena cava being pressed on
preventing the return of blood from the
lower extremities. This complaint may
proceed for many years, untill the Spleen
assumes the immense size before mentioned.
Resolution is not marked by
any critical evacuation. Abscesses
may form. Your prognosis in the early
part of this complaint will in general 
be favourable, but if the Spleen
has obtained a considerable size, & the
disease is of 3 or 4 years standing, it will
then be unfavourable. The causes are
the remote & proximate, the former being
very obscure, it is apt to use after
intermittent & remittent fevers, & then

141 
called the predisposing causes, which 
occurs especially in the East Indies after
what is called the Jungle fever. The Treatment
is the same as that followed in
Chronic Hepatitis, trusting cheifly to
Mercurial preparations.
Genus. XVIII. Nephritis. Cullen
Pyrexia; pain about the Kidneys, often
extending along the course of the ureter
frequent discharge of urine, either thin
& without colour, or of a bright red;
vomiting; numbness of the thigh; retraction
or pain of the testicle of the same
side. 1st. Idiopathic. Spontaneous. 2nd. Lymphtomatic.
The Kidneys are two glandular
bodies, situated in the posterior part
of the cavity of the abdomen, on each
side of the lumbar vertebræ, between 
the last false rib & spine of the ileum

142 
and imbedded in a quantity of adipose
membrane. It is of the conglomerate
kind, & supplied with blood
from the emulgent arteries, which is
returned by the emulgent veins into
the vena cava; it has nerves, from the
solar plexus. The Kidney is coposed of 3
substances, a corticle, tubular, & papillous.
The urine is seperated from the blood, viz
the extremities of the renal arteries, which
ramify very beautifully in the substance
of the Kidney, & terminate in what are
called Cryptu, w.h open into the Tubuli Uriniferi,
from thence into the Papillæ & then
into the calyx or infundibulum, & lastly
it is received into the pelvis of the viscus,
& passes along the Ureter into the urinary
bladder guttation. One Kidney may be the
seat exclusively of inf.n or both; it presents

143 
two sets of symptoms, local & constitutional.
It comes on with a sensation
of heat & uneasiness, terminating in pain,
nausea, chilliness, increased heat & frequency
of the pulse; the pain is regarded
as of a peculiar nature, the Patient
experiencing the sensation of fainting;
the pain in the testicle is of this kind;
that in the kidney is increased on pressure,
the febrile symptoms are moderate for
some days, then begin to be severer with
vomiting; the pain is not confined to the
region of the Kidneys; there is an inclination
to pass urine frequently, w.h is sometimes
red, at others bloody; the bowels
are constipated; with pain, & retraction
of the testicle. The inf.n stage may
proceed to the 7th or 14th day or 4th & 11th 
Resolution will be known if it occurs
by the gradual remitting of the symptoms,

144 
symptoms, accompanied by some critical
evacuation. It has often happened
says Sir George, that you are suddenly
sent for by the friends of the Patient, in
consequence of his having passed a considerable
quantity of blood by the Urethra,
at which they are much alarmed, but
happily on your arrival you have to congratulate
him, it being a very favourable
symptom. If the inf.n does not abate
& proceeds longer than the 7th or 14th day
this suppuration will take place most
probably; no Organ being more prone to
take on the suppurative state, w.h will
be indicated by chilliness & shivering, with
partial sweats; a remission, & towards
evening an exacerbation of fever; the
abscess may burst into the Pelvis of the 

145 
Kidney, & the matter pass of by urine;
it may point externally & be opened by
a lancet or burst spontaneously - but in
both cases death will ensue, the orifice
w.h gave exit to the pus not healing on
account of the bad effects of the urine, w.h
produces sloughing - It may burst into
the Colon, especially of the right side
where the Kidney adheres more firmly. It
may burst into the cavity of the abdomen
if the abscess is situated at the anterior
part of the kidney; & lastly it may
burst behind the Peritoneum. If the
inf.n has been very violent, mortification 
will ensue, known by a cessation of the
pain suddenly, great prostration of strength,
a cadaverous countenance, chilliness,
coldness of the extremities &c. If when
Resolution takes place without being succeeded
by any critical evacuation, we

146
may rest assured that induration has
taken place. This disease is often mistaken
for Lumbago, but it is distinguished
from this complaint by the change
in the urine, nausea & vomiting, the
pain not increased by motion, the numbness
of the thigh; retraction of the testicle,
& fever, w.h symptoms do not occur
in Lumbago; it has also been mistaken for
inf.n in the Quadratus lumborum muscle,
& calculi contained in the kidneys, but
the pain in these two diseases is not accompanied
by much febrile action. Your 
prognostic if Resolution occurs with critical
evacuations will be favourable,
it being the only favourable termination
of this malady. The exciting
causes are cold, external violence, great
muscular excition, calculi. Dissection

147 
proves that it is more subject to abscess
than any other gland. Patients seldom
die during the inflammatory stage of this
disorder. It is known from other abscesses
on account of the urinous smell which
the pus, when the abscess has burst externally,
has. Treatment. In treating Nephritis
your principal object must be to produce
Resolution, by taking from the arm
16 or 20 ℥ of blood; the bowels to be acted on
by an emollient injection & afterwards
by the Ol. Ricini ℥iss, which is the best &
only Kind of purgative to be given in this
disease, the others as the saline & drastic
causing great irritation in the urinary
organs, it is to be repeated in smaller
doses daily; if nausea & vomiting prevail 
the clyster is to be prefered, & used frequently
to take of pressure. (ie) three
times in the course of the day. Blisters

148 
I mean the Empl. Lyttic are here inapplicable
on account of the Cantharides
producing great excitement in the
Kidney; but there are substances which
produce vesications, that may be employed,
as the Allium Porri or Saturnii
made into a poultices by mixing it
with Sem. Lini. far.; the best Diaphoretics
are copious draughts of Barley water &
Mercil. G. Arab., of the former 1 pint of the
latter ℥j. The warm bath & fomentation
will be useful. It will be necessary to
see your Patient in 5 or 6 hours again, &
if you find the symptoms unabated,
blood-letting must again be resorted too,
also local bleeding by means of Cupping
glasses, w.h is to be prefered to leeches.
The Diet must correspond with the general
treatment. Critical evacuations must

149 
be watched for, & encouraged when they
occur. If Mortification takes place nothing
can be done to save the Patient,
but we may rouse him by giving stimuli
as Camphor, Æther, & Opium -
Calculi in Nephritis. Parcelsus was
the first, who attempted by Chemical investigation,
to discover the composition
or component parts of this substance
but from the imperfect knowledge, which
the Greeks had, at that period, of Chemistry,
rendered the attempt unsuccessful. It 
was left to modern times to discover the
different substances, which existed in a
calculus - for this discovery we are undebted
to Dr. Wollastan. They are found in 
the Kidney, Ureter, bladder, and Urethra,
consisting generally of Lithii or Uric Acid.
We must look for the constituent parts

150 
of Calculi, to the different substances
which assist in the formation of urine.
The chief of which are Lithic Acid, Phosphate
of Ammonia, of Lime, and Magnesia; therefore
Calculi may consist of either of these 
these seperately or combined. The manner
of their formation says Sir George is easily
to be conceived, thus, in an unhealthy
state of the urine there may be more
of either of the substances, or of all, deposited,
than the water is able to dissolve, inconsequence
of which a portion remains
which tends to the formation of a nucleus,
which keeps gradually increasing,
the urine as it passes over it having some
of the Phosphates or Uric Acid adhering -
Large stones are sometimes found in this
manner. The longest portion of Urine
consists of water, which if we boil & evaporate

151 
evaporate to the consistence of syrup, afterwards
add Alcohol, & then distill it,
we shall be able to obtain a large portion
of a dry substance called Urea. The colour
of the Lithic calculi varies from a yellow 
to a brown, they are insoluble in water but
soluble in the fixed. Alkalies as Lig. Phospa,
Uric Acid is composed of Oxygen, Hydrogen
& Carbon, & crystallizes in brillant crystals.
Here is a rarer species of Calculi found,
Known under the name of Oxalate of
Lime, being a combination of Oxalic
Acid & Lime; what is called the Mulberry
stone is of this species; the formation cannot
be so easily explained of this as of
the others, as no Oxalic Acid can be
discovered in healthy urine; this Acid
has a great affinity for Lime; Calculus
matter is found in the Urine of the 
colour of red sand, which is uric acid,
it can be decomposed by the action of 

152 
Nitric Acid. Experience has proved that
when any extraneous body exists in the
Urinary passages, there will calculi be 
formed, for as the urine passes over it
will deposit some of the Phosphates upon
it. Dr. Thuthill mentions that there
is in the possession of Dr. Wollastan a
calculus in the centre of which is Oxalate
of Lime, then a coating of urine Acid, this
another of Phosphate of lime, & lastly of
the triple Phosphate. In aged persons inspissated
mucous often acts as a nucleus.
The observations, which have been made,
prove, that the generally of Calculi consist
of a Nucleus in the centre either
of Oxalate of Lime, Uric Acid, Phosphate
of Lime, or the triple Phosphates, & mucous;
it may also be an extraneous
body as the end of a Bougie, a pin &c -

153 
The Phosphates are soluble in Acids as
the Muriatic, the Uric Acid is soluble in
Subcarbonate of Potash or Soda, gr xx three
times a day of this last is given to a Patient
labouring under a fit of the gravel or renal 
calculi, not as was supposed to dissolve the
calculi, but to prevent the formation or
deposit of more. The French proposed injecting
liquids into the bladder containing
alkali; but the solution being obliged
to be made very weak, no happy effect
results from it; the experiments tried in
this Country, have all proved unsuccessful.
Dr. Wollastan has lately discovered
a very rare species of stone which he
calls Cystic Oxyde. Sir Ever.d Home examined
three Gentleman, who were supposed
to have been cured of stones, postmortem,
by the use of alkalies, the 1st had
an enlarged Prostrate with 20 Calcui in the

154 
bladder. the 2nd had 16 with the same
disease of the Prostrate, & in the last the
stone was contained in a cyst - in the
two first Sir Ev.d concludes that the relief
which they experienced during life was owing
to the enlarged prostrate removing the 
calculus from the irritable part of the
Bladder. Of 150 calculi which there are in
Mr. Hunters Museum, 16 are of Lithic Calculi,
6 of Oxalate of Lime, & 128 of combinations
of uric acid, the triple Phosphates
&c.
Genus XIX. Cystitis. Cullen
Pyrexia; swelling & pain in the Hypogastic
region: frequent & painful discharge
of urine, or total suppression of it; tenesmus.
1st. From internal causes. 2nd From
External Causes- Vesica Urinaria or
the Bladder, is situated within the

155 
Pelvis, immediately behind the Ossa Pubis,
& before the Rectum; it is connected
only at its upper & back part with Peritoneum.
When we are able to discover
that the tenesmus, which accompanies the
enumerated symptoms, does not proceed from
faces in the Rectum, we may conclude
the Patient is labouring under Cystitis
which has two sets of symptoms local
& constitutional; it comes on with pain
in the region of the abdomen about the
Bladder, this is soon followed by frequent
& painful discharges of urine, with a
pricking sensation felt at the neck of
the Bladder when the patient wishes
to rid his urine, he now begins to have
cold shiverings, the pulse becomes more
frequent, these symptoms go on increasing
for several days, the pain,
which was at first confined, spreads over
the abdomen, & is much increased on

156 
pressure, extending along the course
of the uretus; the surrounding parts become
effected; the pulse is now rapid
& strong; the secretions diminished; tongue
white; heat increased; considerable thirst;
constipation; evening exacubations attended
with delirium; and in many cases there
is total retention of urine. These symp -
after a longer or shorter duration end in
Resolution, or some unfavourable termination,
a suppuration, chronic inf.n, ulcerated,
& mortification. Resolution is known
by the gradual abatement of the symptoms
about the 7th day attended by some critical
symptoms as a discharge of Blood with
the urine, Diarrhœa, a discharge from
the hæmorrhoidal veins, or an abundant
perspiration - this denotes a favourable
termination. If however the symptoms still
continue increasing after the 7th day suppuration

157
suppuration is then to be expected, which 
will be denoted by coldness of the extremities
& of the back & neck, marked exacerbation
in the evening, & Hectic fever. If suppuration
should ensue, & an abscess form
between the coats of the Bladder, bursting
at last into it, the matter being discharged
with the urine, it will most probably 
terminate favourably. If may also
burst into the Rectum & the Patient recover.
If it burst into the Abdomen. it
is uniformly fatal. It is possible for the
abscess to point externally, & either be
allowed to burst, or opened with a lancet,
& the Patient recover. If the symptoms
after being very violent suddenly
remit, with a total retention of urine,
then it is to be concluded that mortification
has taken place the countenance
is cadaverous, pulse weak & irregular, the
whole system at the same time effected

158
with extreme cold. If after the 7th day
the urine contains pus & Mucous when 
voided, then ulceration & chronic inf.n has
occurred. Diagnosis. From Hysteritis by the
symptoms afterwards to be explained. Prognosis.
If the Disease is moderated by our
remedies. the symptoms being mild, our
prognosis will be favourable, on the contrary
if suppuration & mortification occurs
unfavourable. If ulceration & chronic inf.n
ensue, all will then depend on the constitution
of the Patient, & his former habits.
The Proximate cause is inf.n of the Bladder,
the exciting are cold applied to the body, calculi
in the Bladder; inf.n of neighbouring
parts; substances taken internally as Cantharides;
inf.n of the Urethra in Gonorrhœa;
& lastly retention of urine from mechanical
obstruction. Treatment. Take
16 or 20 ounces of blood from the arm, and recollecting

159
recollecting the strong sympathetic connection
between the Bladder & Rectum, we
must evacuate the bowels with those purgatives
which irritate the least, as the 
Ol. Ricini ℥iss, or Saline purgatives. The
warm bath & fomentations must be resorted
to. Mucilagenious drinks as the Decoct
Hordei cm. Mucil g. Arab. must be taken
in large quantities. If the symptoms do
not abate in four or six hours Blood must
again be taken. Local bleeding by leeches
applied to the Perinæum & Pubis will be serviceable. 
Laxative Glysters may also be
given, & if the pain is very severe add a
drachm of Tr Opii. The Bowels must be Kept
open daily by the Ol. Ricini. If supp.n takes
place nothing more can be done then
to support the Patient by a nutritious
diet. In chronic inf.n & ulceration injections
have been used with advantage with
Bals. Copaib. ℥ss; the Usa Ursi also 2j to ℥ss ter
in Die taken internally; Mecurials with Conium

160
Conium & Hyosciamus of each gr v
Genus XX. Hysteritis. Cullen -
Pyrexia; heat, tension, tumor, & pain in
the hypogastric region; pain in the os
tincæ when touched: vomiting.
The Uterus or womb is a spongy hollow
receptacle; somewhat like a flattened pear,
situated in the Pelvis, between the urinary
bladder & rectum -
Hysteritis seldom occurs except after delivering,
the first symptoms generally come 
on two or three days after. This complaint
has two sets of symptoms local
& constitutional; it commences by the
Patient complaining of heat, & uneasy
sensations in the Uterus & Vagina,
with chilliness, a full, strong, & an accellerated 
pulse, & other signs of symptomatic 
fever; as the disease advances

161
the inf.n attacks the appendages of the
Uterus, when the Patient begins to feel pain
in the back & loins like those of Labour,
the urine is hot, high coloured, & scanty,
with nausea & vomiting, thirst, constipation,
tumefaction, and an increase of temperature
in the part effected, the secretion
of milk is less, & the lochial discharge
is diminished, or both entirely suspended;
If you now examine the Patient externally
that pressing on the Hypogastric
region increases the pain, that the tumefaction
in that part is considerably
augmented; the Uterus is felt to be hard,
and by introducing your finger per
vaginam, & touching the Os tincæ you
immediately produce vomiting; likewise
if the Uterus is pressed the same
sensation is produced; the heat in the
vagina is greatly increased, there is also
tenesmus; the inf.n sometimes extends

162
to the Bladder, & retention of urine
is the consequence. This complaint once
established, goes on increasing in violence
untill the 4th or 7th day, when critical symptoms
may occur as an abundant secretion
of milk, & a considerable flow of
the lochial discharge, besides those usually
enumerated as critical symptoms in other
diseases, these are generally followed by
Resolution, but if the Disease should not
terminate thus, the Patient is in considerable
danger, the symptoms continue augmenting
to the 14th day when he feels a 
remission of the pain with partial sweats
& rigors, exacerbation of fever in the Evening
&c. these symptoms denote that suppuration
has taken place. If an abscess
forms, it may rupture into the vagina,
& the matter be evacuated by the Os externum

163
which will be favourable, but if it bursts
into the abdomen very unfavourable.
If into the Bladder the healing process
will be difficult & frequently end fatally.
If into the Rectum, the Pus being evacuated
per anum, the Patient may recover.
It may rupture externally, but this
will be unfavourable, from inf.n of the 
Peritoneum occurring. It is more common
says Dr. Cullen to find the Pus in the
large vessels of the Uterus. If the parts
loose their natural heat, & there is a 
sudden suspension of pain, with a cadaverous
countenance, then we are
aware that Mortficiation has ensued.
Diagnosis. It can hardly be confounded
with any other disease except inf.n of
the Bladder, which sometimes occurs
at the same time, & will be Known
by the retention of urine, in which case

164
the urine must be drawn off. Prognostic.
It is a very dangerous disease
but if medical aid be resorted too at
the commencement, the Patient generally
recovers, On the contrary if delayed
even for a day, it will prove fatal -
When the symptoms are violent there
is extreme danger. Causes are the Remote
& Proximate. The former is divided into predisposing
& exciting causes, the former
is the particular state of the Uterus w.h
succeeds delivery, the latter is an imprudent
exposure to cold, improper diet,
or ardent spirits. Treatment. We must
begin by lessening the local & constitutional 
excitement as quickly as possible
therefore must take ℥ xvj of blood from the
arm in full stream; if only a small 
quantity of blood has been lost during delivery
more may now be taken. Purgatives

165
Purgatives must afterwards be given, not
those which act powerfully on the Rectum
as these are very improper, but
such as the Ol. Ricini ℥iss, or a saline as
Magn. Sulph ℥j or ℥iss. Glysters also may
be used as the Decoct. Hordei. C. We must
apply warm fomentations to the Hypogastric
region, & give Diaphoretics as the Lq.
Ammon. Acet ℥ss cm. Mistura Camphoric ℥ij
every four hours. The Patient ought to be
seen in 4 or 6 hours, & if the symptoms are
unabated another lb. of blood must be taken,
(the bleeding to be regulated according
to the symptoms afterwards,) & 12 leeches to
be applied at the same time to the
part effected. The Op.g medicines are to be
continued in diminished quantity daily.
If critical symptoms occur they must
be encouraged. The Diet must correspond
with the general treatment. Sedatives are

166
sometimes given to allay pain as Ext
Hyoscimus gr v. If suppuration takes place
you can only support the Patient by nourishments.
If mortification, stimuli is
sometimes given.
Genus XXI. Rheumatismus. Cullen
The cause external and in general known;
pyrexia; - pain of the joints, along the
course of the muscles, attacking the knees
& larger joints more frequently than the
lesser ones, increased by heat. The acute
& vulgar Rheumatism is Idiopathic; it
varies in its seat. a. in the muscles of
the loins. Lumbago. b. in the muscles
of the coxendix. Sciatica. c. in the muscles
of the thorax. The Bastard Pleurisy or Pleurodynia.
Rheumatism is succeeded by
Arthrodynia (Chronic Rheumatism)

167 
After Rheumatism, a violent strain
or subluxation succeeds, pains in the
joints or muscles, increased by motion, more
or less varying, and moderated by external
heat; the joints weak, rigid, readily and
often spontaneously growing cold: no pyrexia
& seldom any tumor. The Lumbago
& Ischias are occasionally acute diseases;
but as they are most generally chronic,
they also properly belong to this place.
Rheumatismus is both acute & chronic,
has two sets of symptoms local & constitutional;
it may affect only one part
or many; be general or partial; the
parts liable to its attacks are the following,
(viz) the shoulder, hip, knee
ancle, wrist, elbow, the muscles of the
loins, & those of the breast. Morbid sensations
are first perceived in the part
effected, & shortly after symptoms of Pyrexia

168
are established, varying according to the
extent of the malady (ie) of the parts effected;
the Patient now complains of wandering
inconstant pains, and is seized with chilliness,
afterwards with increased heat, & frequency
of the pulse, diminished secretions,
& if many parts are effected at the
same time, he looses all power of moving
himself in bed, his pains are increased,
especially towards evening, with exacerbations
of fever at the same period; the 
parts after a time become swelled & tinged
with a pale red colour, the pain when this
appears abates a little, tho' it is very painful
to the touch; sometimes the whole
limb becomes tumefied, & the Patient
is unable to bear the bed-clothes on
him, the urine is high coloured, pulse

169
frequent, strong, & hard, beating from
120 to 130, fever inflammatory, tongue
white & moist, afterwards covered with
mucous then dry, thirst, constipation,
great perspiration, his appetite for food
is lost sometimes attended with nausea
& vomiting; it generally proceeds to the
7th or 14th day when Resolution commonly
occurs, may be marked by some critical
symptoms as a Diarrhœa, miliary
eruptions &c. Some have conceived that
the Patient suffers more pain at night
on account of the bed-clothes & heat, but
this is entirely an erroneous idea, for
most inflammatory diseases have this
peculiar phenomena attendant on them
of exacubations occurring in the evening.
Acute Rheumatism differs from all
inf.n complaints in this respect, we don't
expect either Suppuration or Mortification

170
to happen but only Resolution, when 
the disease declines, not always accompanied 
by critical evacuations, first in
one part then in another, the local & constitutional 
symptoms abating first;
sometimes the contrary effect takes place,
as suppose the Knee joint had been the
seat of disease, has got well, but the pain
is now transfered to the shoulder, so on
alternately shifting from that place to another,
or thus, suppose several of the joints
are effected, they all recover except the
hip-joint, in which the whole of the
pain seems to concentrate, both these
cases the febrile symptoms continue unabated.
If the muscles of the Chest are
effected, there will be a pain & soreness
in that part, with difficult respiration.
If it is not resolved it terminates

171
terminates in Chronic Rheumatism.
Diagnosis. This complaint can be confounded
with no disease except Gout
which will be next described, & then there
will be no difficulty in the distinction.
It is sometimes says Sir George confounded with
Lumbago & Lumbar Abscess, in the former
the pain is increased on motion, & the
latter is attended with Hectic fever w.h
symptoms do not occur in Acute Rheumatism. 
Sometimes a fracture of the thigh
bone has been Known to have been mistaken
for Sciatica, but it has been for
want of a careful examination of the
part. When it attacks the muscles of
the loins it may perhaps be confounded 
with Nephritis, but the state of the urine
will distinguish it. Our prognostic in this
complaint is almost always favourable
but is not regulated as in inf.n by the violence of pain

172
which does not at all effect our prognostic 
although if be ever so severe, but we judge
by the violence of the fever. The constitutional
symptoms have sometimes been so 
violent as to endanger life. Sir Geo Tuthill
says this is a very rare occurrence; for
during the whole of his Practice he has met
with only two cases in which the Patients
died. Causes are the Remote & Proximate,
the last is not accurately settled, for tho we
know that Acute Rheumatism has its seat
among the joints, yet we do not know 
in what part, some have thought inf.n to
exist in the capillary vessels. The Remote
is divided into Predisposing & Exciting causes,
the last is apparent as Cold & moisture
applied to the extremities, where the circulation
is generally low, injuries &c; with
respect to the first, Children and old persons are

172
seldom effect with the disorder, but which 
is confined chiefly to Adults, Youth, and
manhood, and the full sanguineous habit,
winter is especially productive, & also Spring
of this Disease, the prevalence depends on
Climate. Treatment. Our evacuations must
be only to a certain extent - the mode
of cure not being regulated by the pain
but by the constitutional symptoms.
Dr. Sydenham relates, that in his youth
he was much to blame, for if the pain
was severe he was accustomed to bleed
largely, but now having discovered his
error he pursues a contrary mode, being
governed by the constitutional symptoms.
Blood-letting is to be performed untill
the constitutional symptoms are relieved,
not caring for the local. Purgatives must
likewise be given & Diaphoretics, the same
as in Synocha. Where the constitutional

174
symptoms are not considerable venasection 
will not be requisite. The local
symptoms are to be relieved by cupping
leeches, & Blisters, provided the pain occupies
only one part as Lumbago or Ischia,
or when confined to the Knee or any other
joint. Warm fomentations are not here
indicated, as heat increases the severity
of the pain. After evacuations Opium may
be given to procure rest, & promote Diaphoresis
as Pulv. Ipecac. C. gr x at bed-time:
The Diaphoretics to be given are Lq. Ammon
Acet ℥ss Mist. Camphporœ. ℥ij every 4 hours or
Pulv Antimon. gr v or Ant. Tart gr. /4 - every 4 hours.
The Purgatives to be given may be either
Calomel or Salines: The diet is to correspond
with the general treatment: Combinations
of Conium & Calomel are often useful
as Hyd. Sub. gr./4 Ext. Conus gr v Hy.t Pil Cap.h orm. 6. hours
If critical symptoms occur they must be
encouraged. Arthrodynia or Chronic Rheumatism.

175
Rheumatism. the symptoms of this disease are
enumerated in page 167. this complaint
is said by Dr. Cullen to be the sequel
of the Acute form, but Sir George
says it may be & often is a primary 
disease, liable to attack all those parts
which the Acute does, but not in general
effecting so many parts at the 
same time. It has been observed by some
writers that the limits between Acute
& Chronic R. are not discernible.
Diagnosis: from Syphilis by the pains
being relieved when the body is warm
by the situation of the pain, as in Syphylis
the pain is principally refered
to the bones, whereas in this complaint
the pain is the joints. A calculus will
often be very difficult to discriminate,
so much so, that the celebrated Boerhave 
mistook his own complaint, which
he supposed to be C.R. but after death dissection

176 
proved that it had been a calculus under
which he had been labouring. Prognosis
always favourable, & unattended with danger
but it may trouble & afflict the Patient
for months or years & probably during his
whole life. The Proximate Cause is not ascertained:
The Predisposing are variable Climates
and previous attacks: The Exciting
are cold & moisture, but frequently it is
only the sequel to the Acute stage -
Treatment. The remedies to be used in
this complaint are partly such as are
calculated to act upon the part effected,
& such as are apt to effect it through
the medium of the Constitution -
Evacuations here are not employed to
the same extent as in other inflammatory
diseases. The use of the lancet
is inadmissable - & Purgatives are

177
given only to relieve a confined state
of the bowels, not to procure great discharges-
for which we prescribe Hyd. Sub. gr v
The action of which may be increased
by a purgative salt taken 6 hours after
as Magn. Sulph. ℥j, or the vegetable
purgatives may be given as Pulv Rhæi
2j Calomal gr iv or Pulv Jalap. 2j Calomel
gr v or Scammony & Calomel. Diaphoretics
are frequently serviceable in
this malady. Mercury has been used
with very good effect in alterative
doses & we may give it in the following
form, Ext. Conii gr v Hyd, Sub. gr ss
to be made into a pill & taken in
the morning & at noon, then at bed-time
this powder Pulv. Ipecac. C. gr x, the
Pil & powder to be repeated daily - this
is found to be a very successful mode of

178
treating this malady. Some have recommended  
the Pulv. Antimon gr v O.n. horâ decubitus,
but it is not so serviceable here
as in the Acute form. The Peruvian Bark
has been given in some cases, but not with
any great success. Sir George Tuthill says
it may be given with great advantage
when the pains have subsided, & there only
remains a weakness & rigidity of the joints.
Guiacum has also been used in the form
of Tincture, as Tr. Guaici. ʒss ter in Die.
and the Liq. Arsenicalis - The Local remedies
are Cupping Glasses or Leeches
applied to the part effected, also. Blisters,
warm fomentations, the warm bath, this
last especially when several of the joints
are effected, the perspiration being afterwards
Kept up - We also use friction with
the stimulating embrocations as Lini. Saponis

179
Lin. Ammon. For. & the Lin. Camph. C.
Some have thought, that the benefit derived 
from these liniments, has chiefly been
owing to friction, & not to any property
which they possess - Cold affusion is used
by some; likewise Electricity, this last
is a very uncertain mode of treating
this complaint. Flannel rollers often give
great relief.
Genus XXII. Odontalgia. Surgeons. Disorder
Genus XXIII. Podagra. Cullen -
Hereditary arising without apparent external
causes, but generally preceded by an
affection of the stomach; pyrexia; pain
at some one of the joints, generally at
that of the great toe; certainly attacking
the articulations of the feet & hands chiefly

180
returning at intervals, and often alternating
with affections of the stomach,
or other internal parts. 1st. Podagra regularis;
with considerably violent inflam.n
of the joints, containing for several days,
and receding gradually with swelling,
itching, and desquamation of the effected
part. 2nd. Podagra Atonica. Debility of the
stomach, or other internal part, either
without the usual inf.n of the joints, or 
with slight & changing pain in them; &
with dyspepsia, or other symptoms of debility,
often quickly alternating. 3rd. Podagra
retrograda. with inf.n of the joints quickly
disappearing, soon followed by debility of the
stomach, or of some other internal part.
4th. Podagra Aberrans. with inf.n of some
internal part; sometimes preceded by

181
inf.n of the joints, which quickly disappears.
The Gout is sometimes accompanied
with other Diseases - that species w.h
is of most frequent occurrence is Podagra
Regularis. Gout is a malady in which
the sufferings of the Patient are extreme,
and in which little relief has been obtained
from any remedies yet Known,
although there is no disease where
more has been tried. The best description
of Podagra is that given by Dr. Sydenham, 
who was a very accurate describer of 
diseases - Boherave mentions of him,
that he Knew of no person or Physician,
who had described diseases more accurately
than Sydenham since the days
of Hippocrates. And what is singular
he did not attempt to write a description
of Gout, untill he himself had
suffered under the malady in various

182
forms for the space of thirty years -
An Attack or Fit of Gout is generally preceded
by lassitude & weariness; low spirits; the
Patient complains of a load & fullness of the
stomach after eating, & is apt to fall
asleep; pain in the head; eructations of
wind; flatulency; heart-burn; pains in
the feet & cramp seizing them; a pricking
sensation in the thigh; the appetite
very good the day preceding; the
habit is costive; the Patient goes to bed
and sleeps soundly untill about 2 oclock
in the morning, when he is awakened
with a severe pain generally in the great
toe, (but other parts of the foot may be
effected) giving to the Patient the sensation
of dislocation of the ancle, accompanied
with a sensation of coldness, as
if cold water was poured down, slight
shivering, then increased heat & frequency

183
of the pulse & other febrile affections;
the most distressing symptom
is the pain, which becomes more violent
every hour untill the next evening (ie)
four & twenty hours from the commencement
of the Paraoxysm, affecting the small
bones of the foot, which feel as if they
were strongly squeezed by the hand -
the Patient is unable to bear the
bed clothes on the part effected; the night 
is thus passed in extreme pain, & restlessness,
which symptoms continue to
distract the P. untill the period above
mentioned, when if it is a favourable
case the symptoms shall subside so
quickly, that in two or three hours after
the cessation of the Paroxysm, he falls
asleep, & is surprised when he awakes
to find the part red & swelled but no
pain; You are not to think that 

184
the Disorder has ceased, as it returns
again the next evening, but with less
violence, sometimes the pain concentrating
only in one foot, at others in both;
& in some cases first in one then the other
alternately, so that the Patient suffers
for an indefinite period; but if a person
who is of a robust habit has a fit
of the Gout (being the first attack) then
the malady subsides in about 14 days, the
paroxysms gradually diminishing in
violence; very different will be the termination
in those advanced in life,
& who have been accustomed to fits for
sometime, in them the disease will last
for two, three, four months or longer, attended
with costiveness; scanty urine depositing
the lateritious sediment; the action
of the stomach greatly deranged, want of

185
appetite; rigors towards evening - as
the pain subsides in the part effected
the Patient complains of intolerable itching
& desquamation of the cuticle takes
place. A fit of the Gout generally bares 
the Patient better, than he was before
the attack, & the reason of this is very
plain as before the occurrence of the fit
he may have been for some time labouring
under dyspeptic symptoms
which he looses after the fit - this observation 
says Sir George is to be admitted
with regulations, for tho' the Patient may
have lost all his Dyspeptic symptoms,
the functions of the system are more
liable to be disordered from slight causes.
Persons once attacked with this malady
are liable to its returns, being one of those
disorders, which leave in the system a predisposition

186
predisposition for a recurrence; the second 
attack generally occurs at an interval
of three years; the third at an interval
of two years; the fourth of one year, then
two in one year, & finally the Patient may
only be free during the heats of Summer
(ie) two months in the year; the symptoms
in the latter cases are not so severe,
& in those protracted attacks it is the constitutional
symptoms which are most
effected; after the first attack other joints
are liable to be the seat of the disease alternately
or at the same time, as the
hands & fingers - also in the first attack
the joints recover their usual suppleness,
but not so when the Patient has suffered several,
the joints then become rigid, &
a state of lameness is induced. Calcareous 
substances are deposited in the feet

187
& great toe, the kidneys likewise for
taking of the same action - There is often
a regular transition from Podagra Regularis
to Podagra Atonica - which is that species
which consist of a morbid state of
the stomach, either without the usual 
inf.n of the joints, or with slight & changing
pain in them, accompanied by flatulency,
nausea, vomiting, cramps in
the trunk of the body, which are relieved 
by evacuating wind, & of the upper
extremities, pulse intermitting, the
Patient is very irritable & anxious
& death suddenly ensues - or the disease
may attack some of the thoracic or abdominal
viscera, in which cases it
usually soon destroys the Patient, or it
may effect the head, when headache, vertigo,
dizziness, palsy & apploplexy is the
consequence or the Patient is suddenly destroyed,

188
destroyed the symptoms before that event occurs
being a noise in the ears, full pulse,
oppression at the breast, and preternatural
redness of the countenance. There is no complaint
which the Patient has been subject
too, but what he may be effected with at
the commencement of a fit of the Gout,
hence says Dr. Tuthill you have Writers speaking
of the Gouty sore - throat &c - It is certain
that when Patients are troubled with
any of these affections, during which he is
attacked with Gout in his feet, that they
gradually abate, & at last totally subside
tho' such things occur the conclusion is 
not just, that they are symptomatic of
Podagra. No person (or at least it is very rare)
is ever effected with Podagra Atonica, who
has not been repeated by subject to Podagra
Regularis; but if suppose a Patient 30 years

189
of age, not born of Parents subject to
Gouty affections, is seized with dyspeptic
symptoms &c, it would be impossible to distinguish
wether the Patient was suffering
under Podagra Atonica or not. 
Podagra Retrograda, is nothing more than
at the beginning the Patient is effected
with Podagra R. & at its termination
Podagra Atonica. as to Podagra Aberrans 
Dr. Cullen admits himself that he
never saw this species - Diagnosis in
Podagra Regularis is a malady which
may be confounded with Rheumatism
the distinction is, their mode of accession
being totally different, & Rheumatism does
not consist of repeated Paroxysms coming
on at certain hours, & departing again at particular
periods. Prognostic. Podagra Reg.
is unattended with danger except in old
people, when the danger arises from weakness
Podagra Atonica, is extremely dangerous.

190
The causes are divided into the Remote
& Proximate, the latter is very obscure & all
we know is that it is a specific inf.n
attacking the joints, but what part or
structure is effected is unknown; respecting
the Remote causes, it is divided into
Predisposing & Exciting, of the former, the
most powerful is that which is derived
from the Parents, or being once affected
with Podagra, you are liable to its recurrence;
it is peculiar to cold & temperate
climates; those most subject to it are
persons of a robust form, seldom attack
the delicate; affecting also those who have
led an indolent, inactive, & luxurious
life, taking fermented liquors to excess,
on the contrary, those who live sparingly,
& are constantly employed, as the common
soldier for instance, are seldom troubled
with this malady. This Disease 

191
seldom makes its appearance before
the age of 30 or 35, except when it is hereditary,
then it sometimes attacks persons
at a much earlier period. The Exciting
causes are, 1st. Suppose a person who has
been in the habit of being constantly employed
during the day, & of living well,
suddenly ceases from any occupation, & begins
to lead an indolent life, but not to
alter his mode of living (ie) of eating,
this state is called the exciting cause, or
it is sudden derangement of digestion,
or intoxication, or perspiration being
suddenly checked, or exposure of the feet
to cold, or external injury of that part,
or in fact anything that tends to reduce
the circulation suddenly in the system,
or that particular part. Dr. Musgrave
observes that in those in whom Gout is
hereditary, tho stomach is generally affected

192
& that those born of old Parents,
(meaning that the person was born after
his father was attacked with this malady)
are more liable to this disease than
Persons who are born of younger parents,
If a person never had the Gout, & had
attained a considerable age, whatever
might be his mode of living, he would
not be subject to an attack of this disease.
Podagra Atonica generally attacks those
of a weak habit of body; Podagra Regularis
those of a robust. The Athritic
symptoms which are apt to arise in
Podagra are in consequence of cold,
or obstruction of the bile. Treatment
1st. of Podagra Regularis. There are three
considerations which direct our
mode of treatment, 1st that Podagra
Regularis is unattended with 

193
danger, 2ndly that Podagra Atonica
may be induced, & 3rdly that this is a
very dangerous disease. We do not regulate
our mode of treatment either
by the local or constitutional symptoms,
which makes the plan of cure totally
different from all other inf.n diseases,
& our Reason is, that experience proves,
whatever is done to remove the local
symptoms endangers Podagra Atonica
placing the Patient in imminent danger,
by converting a malady not attended
with danger into one that is 
highly dangerous - The inf.n may be
removed, at the hazard I have mentioned,
by cold applications, as well as the
exquisite pain, & Patients, in whom the
pain is exceedingly acute, will chose rather
to run the risk by plunging thin feet
into ice water than endure the agony -

194
it does not necessarily follow that Podagra
A. shall be induced, for the Patient
may recover - but on an average we may
conclude that this plan destroys one Patient
out of ten, & when that is the case, it ought
not to be recommended, on such constitutional
[cross out] treatment as Bleeding & Purging
which have also been found to induce
Podagra A. these have been abandoned
by the most careful Practitioners - All
that we can safely do, is to order the bowels
to be kept gently open, the skin a little
moist, & the body of an equal temperature 
- the treatment is not entirely confined
to the Paroxysm, but also to prevent
or moderate its return. What has
been known to remove Podagra altogether
is sold in the shops under the title of
Eau medicinale, & Sir George Tuthill mentions

mentions many Persons, who after taking
this immediately recovered - It was tried
to decompose this medicin by the aid of
Chemistry, & from the experiments made
it is generally believed in England to
consist chiefly of the Colchicum Autunmale
- Sir Everard Home, who is himself a
martyr to this malady, relates in confirmation
of the above supposition that
when he is seized with Podagra, by 
taking an Infusion if Colchicum he experiences
the same relief, & at the same
time from taking the Infusion as he
did from taking Eau medicinale, &
asserts that Colchicum is as certain a
cure for Gout as Mercury for Syphilis.
Some Persons, who have taken of this remedy,
say that it affords them great relief
but injures their constitution & vice versa

196
some have died immediately after taking
it, but wether their death is to be
attributed to the remedy is a question,
which has detered many from making
use of the Eau Medicinale, therefore
it is not so much used as four or five
years ago - the Acetum or Tinct. Colchici ʒs
per dos. During the intermission we must
teach the Patient how he must conduct
himself, 1st. to avoid the exciting causes, take
gentle exercise, if accustomed to wine or
spirits not to abstain from them suddenly,
regulate the alimentary canal &
attend to Diet, using cold bathing and
when the joints are rigid & stiff employ
frictions; if weakness prevails give tonics -
In Podagra Atonica, during the intervals
we must endeavour to invigorate the
system - the plan of treatment pursued by
the late Dr. Sydenham was this, when slight

197
& transient pains were to be felt
in the part usually subject to them,
& after a time these needed, when he began
to be troubled with nausea, vomiting,
pain in the stomach, flatulency, heartburn
&c making the pressure of Dyspepsia,
it was his custom immediately
on the occurrence of these last named
symptoms to take some diluent in order
to reject the contents of the stomach,
afterwards to take 20 or 30 gtt of Tr Opii in
a glass of Madeira wine, then he went
to bed & endeavored to compose himself
to rest - by adopting this plan he
generally prevented the Gout from proceeding
& soon recovered - Sir George very
much approves of this mode, & thinks its
the best we can pursue, but besides the
means above named, he thinks it necessary
at the same time to induce the Gout

198
to the feet, by applying to them
Cataplasms, blisters, poultices & fomentations,
by which means if we should be
so fortunate as to translate it to the feet
then all danger is over, but if on the
contrary neither Alcohol or Opium produce
any mitigation, then the Patient
dies - The Bath waters have been
much extolled for their efficacy - If the
Gout should effect the Thoracic Viscera or
those of the Hand, the Patient will be
in greater danger than when the Stomach
is effected - The Gout in the head will be
Known by the change produced in the
powers of the understanding - this is a
hopeless case, but we must endeavour
to induce the Gout to the extremities by
stimulants. April 9th. 1821

199
Order III. Exanthemata
Diseases commencing with fever; at a definite
time eruptions, often numerous
on the skin, often contagious; affecting
a person but once during life.
Genus XXV. Variola. Cullen -
Contagious synocha, with vomiting, & pain
upon pressing the epigastrium. The eruption
of small red pimples takes place on the third
day, & ends on the fifth; which in the course
of 8 days suppurate, & finally dry & fall off
in crusts, often leaving little pits in the skin.
The species are, 1st. Variola discreta; pustules
few & distinct, in circumscription circular,
turgid; the fever ceasing upon the eruption
taking place. 2nd. Variola confluens; pustules
numerous, confluent, having irregular margins,
flaccid, & little elevation; the fever
remaining after the eruption. It is to be

200
observed that this last species occurs
in two forms, being accompanied either
by Synocha, or Synochus & a putrid diathesis;
concerning the former species, the changes
which take place in it are exceedingly
regular, & the constitutional symptoms are
those which are first manifest; it has been
remarked that the febrile symptoms commence
soon afer noon, when the Patient
is seized with languor, chilliness, drowsyness,
afterwards with increased heat &
frequency of the pulse which is at the same
time full, thirst, the secretions of the body
are diminished, pains in the back, loins
& lumbar region, sometimes tho' rarely in
the fauces, drowsiness is occasionally so great
that coma supervenves, vomiting, at first
the ingesta only is brought up afterwards
bile, pain upon pressing the epigastrium,
a bilious diarrhœa; adults are apt to perspire

201
very much, and infants are subject
the night before the eruptions break out
to epileptic fits, starting in their sleep,
& twitching of the muscles of the face,
cramps in the legs, & exacerbations of fever,
the eruptions appear on the third day, first
on the face & neck then over the body
in small red pimples, & are completed
by the fifth accompanied with sneezing;
as soon as the eruptions appear the fever
begins to diminish, & by the 5th day
vanishes, on the 8th day small vesicles
make their appearance on the pimples
containing a whitish fluid, which becomes
opaque, & is converted into pus,
the vesicles now are of a spherical form,
about the size of a pea, surrounded by
an inflamed circular margin; about
the 7th day if the Pustules are numerous
the face is swelled, the eyes also are tumefied,
often obscuring the sight, when this

202
subsides, the lower extremities become
swelled - On the 11th day the pus is discharged,
which drying & hardening, falls off
in crusts, leaving the skin of a dark
brown colour, which will gradually disappear,
but if on the contrary the pustules
are numerous, & the matter discharged
of a dark colour, pits are generally
found in the skin. Sometimes on
the 7th day if the symptoms are violent
great irritation in the throat & fauces
will prevail, with increased secretions
in those parts, hoarseness, deafness, &
the febrile symptoms considerably increased,
this only happens in Variola discrete when
the pustules are numerous - the fever often
returns on the 11th day but lasts only a short
time. In Variola Confluens some of the
Phenomena are different from those of Discreta
& experienced to a greater degree - it differs

203
in its accompanying fever which is
sometimes Synocha, at others Synochus, the
first stage of which is often very short, the
characters of Typhus soon presenting themselves,
in the worst cases of this malady
petechia will appear on the first day
before the eruption, accompanied by
hemorrhages, which is highly dangerous;
in children epileptic fits will take place
on the 1st day - a diarrhœa will sometimes
precede the eruption, & continue a day
or two after, if the stools are fetid, the
disorder may be expected to be highly
putrid; the pustules will sometimes appear
in clusters, & form matter sooner
than those in discreta, but are smaller
than them, of an irregular figure, & little
elevated, sometimes the face is completely
covered, appearing like one large vesicle,
not surrounded by an inflamed margin, but
flaccid, containing a dark brown coloured fluid

204
& in the worst cases coagulated blood,
which is discharged on the 11th day, & form
crusts which are a long time disappearing.
The Pustules in Confluens tho' crowded 
in the face are often few in other
parts of the body. Salivation is a constant
attendant of this species especially in
adults. When the eruptions appear
the fever does not cease but only remits
for a short time. If inf.n affects the
the throat & fauces & there is no salivation,
the skin will show a disposition
to mortification - If coma does not occur,
the Patient is troubled with vertigo
headache, oppression of breathing &c which
terminates his existence on the 11th day -
The Diagnostic symptoms are the child
starting in his sleep with twitching of the
muscles of the face, & having an epileptic fit
the day before, if the infant says Dr. Sydenham

205
Sydenham is affected with these symptoms, he
should have no hesitation in saying that
small-pox would appear; it is to be distinguished
from Variola confluens, by the febrile
symptoms being milder, the stools
not being fetid, there being little or no salivation,
& the eruptions in the confluens appearing
on the second day & forming an
erythematous surface. Prognosis - if the eruptions
are flat, livid, numerous interspersed
with Petechiæ, & retrocede, then followed
by coma, a state of the Brain ensues
from which the Patient seldom
recovers; likewise a great action in the
temporal arteries & carotid, & finally difficult
deglutition, the whole of the above
symptoms are considered as highly dangerous
but if the eruptions, few in number, appear
on the third day, when the fever which
has been Synocha ceases & does not again return,
those are considered as favourable symptoms

206
The causes are the Remote & Proximate
the latter is unknown, the former is divided 
into the predisposing & exciting cause,
with respect to the former of these, all persons,
who have never been attacked with
it, are predisposed to the effects of contagion,
which predisposition ceases after
they have had the malady once. It often
occurs says Sir Geo Tuthill, that although
the Patient has been only slightly affected,
the constitutional symptoms being
little or none, with fur eruptions, so as
scarsely to be sick, yet this shall preserve
the Patient from any recurrence of the
disorder thro' life, notwithstanding it
is as severe a malady as the human
frame is subject too. The Exciting cause
is specific contagion, this disease is
produced by no other cause, & as a
proof of this operation, it is well known,

207
that Variola was wholely unknown
in America, (the atmosthphere of which
varies in its different States,) untill it
was carried thither from Europe. Treatment.
It is the fever that must direct
our treatment here; the form which the
eruptions take will also regulate it;
but the renewal of the fever & the form
that it then assumes is the most important.
The Practice formerly adopted
was to cause the eruptions to appear
sooner than usual, thinking that numerous
eruptions quickly appearing was
a favourable sign, & in order to promote
this they caused the Child to be confined
to this bed, covered with many clothes, the
doors & windows were kept closed, with a 
fire in the room, this mode of cure was
pursued till dear bought experience taught
as to the contrary, and we are now well 
are that the most favourable symptoms are

208
when the eruptions are small & scanty -
[cross out] as then the fever will be less, therefore
our treatment now is totally different -
If no secondary fever supervenes the Child
is safe, but if it does you cannot be answerable
for your Patients safety untill you
discover what form the fever will assume
& its violence, if it be severe he will be
cut off on the 11th day. Our endeavour must
be to moderate the fever w.h precedes the
eruption & to produce scanty eruptions, therefore
as heat has a tendency to increase
the eruptions, we must direct the Patient
to be kept perfectly cool, by opening the door
& windows, to allow a free current of air
to pass through the room, the curtains of
the bed to be undrawn, & little clothes
covering it, the bed also should be a mattrass
not a feather bed as this is known
to engender heat; the Child should have

209
cold drinks given it when it is thirsty,
by pursuing this method of treatment
we shall greatly abate the violence of
the symptoms. Dr. Sydenham directs the
Patient during the constitutional symptoms
to be suffered to run out of doors, or to remain
in bed in the manner I have just mentioned.
As soon as the fever begins a light
farinaceous diet should be given, and with
respect to medicines, an emetic either
of Ant. Tart or Pulv. Ipecac. followed by
a saline or mercurial purgative, the
latter is prefered as Calomel gr iij to be
continued daily, if nausea prevails prescribe
an effervescing draught. Blood-letting
has been much recommended by Dr. Sydenham
during the eruptive fever, but it 
is not now thought to be requisite, except
in cases where the violence of the symptoms
cannot be reduced otherwise, & the reason
is that this Disease debilitates & weaken the 

210
system very much, and venesection has
been thought to have a tendency to produce
that effect & to increase it when
present. Diaphoretics may also be given -
When the febrile action ceases, the medicines
used during that state will be 
unnecessary, but the Patient should be
purged every other day for a week with
the Black draught - we may, after proper
evacuations, if the child is restless, give
Ext. Hyoscimi. If the secondary fever supervenes,
it is to be treated in the same 
manner as the fever which precedes the
eruption. If the carotid artery beats violently
leeches must be had recourse
too. Treatment of Variola Confluens is
divided into two Kinds, (ie) according as
the fever which prevails, be Synocha
or Typhus. If Synocha, the more violent
the febrile action is which precedes the

211
eruption, the cooler ought the Patient
to be kept. We commence our medical
treatment of this complaint in the same
way as in Variola discreta, by giving an
emetic succeeded by a purgative, & afterwards
Diaphoretics; the emetic may also
be given in the secondary fever, provided
it be Synocha by using these means we
generally succeed in moderating the symptoms.
No treatment has yet been discovered
that will shorten the course 
of Variola. Our object is to moderate
the fever which precedes the eruptions,
& to produce as scanty eruptions as
possible - If unfortunately the case
should be of a different nature, that is,
the fever of a Typhoid type, our endeavour
must be to support the Patients strength
& give him Tonics, as the Peruvian Bark
with Muriatic Acid & wine - in fact, pursuing

212
pursuing the same mode of treatment as
in Typhus; if the pulse at the wrist be
small, at the same time that the carotid
artery beats violently blood must be taken
either from the neck by cupping glasses
or by leeches from the temples; Blisters also
may be applied to the back of the neck,
cold to the head, and the feet to be immersed
in warm water. Internal inflammations
often succeed Variola, when such
remedies are to be used, as mentioned in the
treatment of such viscus when inflamed -
If inf.n affects the throat & fauces a Blister
is to be applied to the outside of the throat
& Gargles of Myrrh &c used. The vomiting
which sometimes accompanies this disease
is best allayed by saline Draught in a 
state of effervescence with a small addition
of Opium. If Diarrœha supervenes, and does

213
not produce weakness, it is to be encouraged. 
If the Patient is attacked with
Perspiration, the cooling plan is to be persisted
in the more. If the eyelids adhere
a little of the Ung. Spemaceti is to be
rubbed on the edge of them. If the Eruptions
suddenly disappear, our endeavour
will be to reproduce them, by giving internally
musk, æther, camphor, & Opium,
& applying to the surface of the lady
warmth by fomentations, or a Blister -
If the neck be swelled camomile poultices
are to be applied to it. In order to prevent
pits in the skin some Practitioners
have recommended opening the vessels
early. The first account we have
of Small-pox is from the Arabian Physicians; 
the Greeks are quite silent on the
subject, it being probably unknown to them.
In order to prevent the disease, no Method

214
has been practiced with to much success
as Innoculation, which was introduced
into England about 100 years ago -
It happened that Lord Montague was sent
as Ambassador from this Country to Constantinople,
accompanied by Lady Mary
Worthy Montague, who, in visiting the
Seraglios of that city, was astonished to find
the children had no marks or pits on 
them, which led her to enquire concerning
the reason of this, when she was informed that
it was owing to a certain operation which
was performed on them, which was merely
to raise the skin with a scalpel, & to introduce
a little of the matter, contained in
the vesicles, from a child labouring under
the disease. As soon as this Lady returned 
to England she had her own Daughter innoculated,
(who was the first person that
underwent the Operation in this Country)

215
by a Surgeon of the name of Maitland -
afterwards it was tried on some criminals,
(who had been left for execution, on condition
that they should receive a free pardon,)
with very great success, and in 1775 the
the Royal Family were innoculated,
after which it became much in vogue,
& members were innoculated - a Surgeon,
who met with the greatest success in the
Practice, was a Gentleman of the name
of Sulton, who had innoculated many
hundreds, with very few unfavourable cases,
his mode was to take the fluid from the
vesicles as soon as they appeared - Some Practioners
prefer a different mode, & take
the matter when it is formed into pus.
There is a fact which is well Known by medical men & believe
by them; & you will find says Sir George
Tuthill unfortunately only by them, that the
mildness of the disease does not proceed from

216
from the Infant's being innoculated
from another, who was labouring benignly
under an attack - but this you will never
be able to persuade the Mother - Within
a few years says Sir Geo. Tuthill another
mode has been adapted of preventing 
the mortality which exists in Small-pox,
which is called Vaccination. It
has been long known in England that
the teats of a Cow will sometimes ulcerate,
& it has been discovered, that if the
Servant who milks the beast has a scratch
or cut on the hand or fingers, which comes
in contact with the matter from the
ulcers, it produces in a day or two an 
inf.n of the part, & in a few days a vesicle
appears, from which matter is discharged
& hardened, afterwards falling off in crusts -
the Person, who had been thus affected, has

217
never been known to have an attack
of small-pox - therefore it was first proposed
by Dr. Jenner [cross out] to vaccinate, especially
as this, which was called the Cow-pox,
was not communicable through
atmostpheric air, nor was it contagious,
which Varicola is, & likewise because
it produced no constitutional
symptoms that were of any consequence.
On account of these reasons, and also
their thinking that it was equally
as efficacious as Innoculation, & attended
with much less danger, that a law
was passed in some countries, probibiting 
medical men from Innoculating
with the small-pox matter, & that Vaccination
was only allowed - this has 
been the case in Denmark, where the 
disorder has been unknown for many years

218
The mode in which Vaccination is
performed is this. You are to take a lancet
changed with the Cow-pox matter,
and introduce it under the skin - the
consequence is that the matter is absorbed
causing in a few days inf.n of the part,
on which a pustule forms, & pus is discharged 
from it, which hardens & falls
of in a crust, leaving a pit on the skin -
When Vaccination was first Known 
in England, it was very much opposed
by many Practitioners, and Dr. Tuthill
is inclined to think very properly, as
it induced a stricter enquiry to be
made. Those, who were the warmest supporters
of this Practice, asserted that
Vaccination was as capable of preventing
the occurrence of Variola, as small pox
matter, (ie) Innoculation; but we

219
know this assertion not to be correct,
as several persons in different parts of
the Country, who had been vaccinated,
have afterwards had the Small-pox, but
the attack has been very mild, compared
to that, under which those Persons laboured,
who had not undergone this Operation.
By a computation, which was made by
order of the Vaccine Board, it was found,
that of Persons who were vaccinated in
the Metropolis, only one in a hundred was
attacked with Variola - & we may say,
(says Dr. Tuthill), that not one, in a thousand
or a million of those who have
been innoculated, have had small-pox.
However the effect above related of vaccination
authorizes its use - but it certainly
has not been long enough practiced for
us to know its value, & that as yet it ought

220
as yet only to be considered as an
experiment.
Genus XXVI. Varicella. Cullen.
Synocha; pimples, after short & slight fever,
running into pustules like the small
pox, seldom suppurating; in a few days
ending in scales, seldom or never leaving
any scars - This Complaint has a
strong resemblance to Variola - it sometimes
occurs without any febrile action,
but the fever has been known to last for
3 days before the appearance of the Eruptions
It generally commences with slight febrile
action on the first day, which ceases on
the 2nd when the pimples appear, these often
come out all at once on the Back, tho' the
face & neck may sometimes be first effected,
are of a red colour, & uniformly distinct &
small, commencing at great & irregular

221
distances from each other, quickly 
increasing in magnitude, on the 2nd day of the Eruption
vesicles are formed, which become opaque
on the third, & on the 4th attain their full magnitude & discharge the
fluid which they contain, this hardens
& falls off in scales in the course of a week
leaving generally no pits - the Fever never
returns in this Disease. Our Diagnostic
is always favourable; with respect to
our Prognostic, it must be formed after
the most particular observation & enquiry,
for it is very necessary not to mistake
Varicella for Variola, & this is the reason,
"suppose you are called in to see a 
Child labouring render Varicella, it being
the 3rd or 6th day of the attack, when its appearance
is most like to that of Variola,
you make but few enquiries, & views the
complaint only superficially, asking the
Parents perhaps is the Child has ever had the

222
small-pox or been vaccinated, they
reply no - this confirms your opinion that
the Disease under which the Patient is
labouring is Variola, you inform the
Parents, & lead them into the same
error as yourself - a few years after
the Boy may be attacked with Variola,
(in consequence of the family [cross out] putting
implicit faith to your statement, have
not thought it requisite to have him
vaccinated) & fall a martyr to it - from
your neglect - we distinguish Variola
from Varicella by the following - by the
progress of the latter being much more rapid,
than that of the former which is
very slow, the crusts not falling off till
the 13th or 14th day - also in the latter the
fluid does not assume the consistence
of Pus, & the complaint is over in a week

223
being formed into vesicles on the 2nd day
becoming opake on the 3rd & on the 4th attaining
their full magnitude &c - The exciting cause
is specific contagion; but with respect
to predisposition, all those who have never
had the Complaint are liable to it, tho'
it seldom occurs but in Children - Varicella
has all the characters of the order
Exanthemata. Treatment - must be the
mildest possible, there being no danger,
we must confine the Child to a vegetable
diet & give him saline purgative,
if the febrile symptoms continue more
than a day, Diaphoretics must also he
had recourse. This is often so mild a
disease as not to require medical attendance.
Genus XXVII. Rubeola. Cullen,

224
Contagions; with sneezing; a flow of
thin humuor from the eyes, & a dry & hoarse
cough. On the fourth day, or little later,
the small pimples, hardly elevated, break
out in clusters, and after three days form
small mealy scales. 1st. Rubeola vulgaris
cum febre Synocha: small confluent
pimples in clusters, & hardly elevated.-
It varies - a. with severe symptoms, & an
irregular course. b. Accompanied with Cynanche.
c. Accompanied by a putrid diathesis. 
2nd. Rubeola Parioloides: (measles
like small-pox -) with distinct & elevated
pimples. Rubeola vulgaris has all the
characters of the order Exanthemata, it
begins by a febrile state which is accompanied
by languor, chilliness, increased heat
& frequency of the pulse, there is also general
disorder in the system; the fever increases,

225
increases, attended with considerable sickness,
great heat, thirst, loss of appetite,
the tongue is white; if coma does not succeed,
there is a heaviness in the head, &
drowsiness; also other symptoms characterize
this disease, as sneezing, which occurs in
consequence of inf.n affecting the Scheiderian
membrane of the nose; brightness of
the eyes from whence flow a thin humour;
the eyelids often swell; the Patient
has a tendency to perspire; a bilious diarrhœa
commonly ensues, the stools being
of a greenish yellow if the Child is cutting 
its teeth; the eyes at this period are very
sensible to light: symptoms of Pneumonia 
inf.n now & sometimes sooner,
make their appearance; the respiration
becomes disordered, with a dry, hoarse
cough - these symptoms generally occur
on the 1st. 2nd & 3rd. day, & is called the first stage.

226
The second or Eruptive stage begins 
commonly on the 4th day, about which
time small red pimples make their appearance
on the forehead, which run into
clusters, (but are at the same time very
distinct) & form marks, like stains rising
above the skin, and perceptible only to
the touch; afterwards broad spots spread
over the face & extend downwards, this
happens on the 2nd day of the Eruption,
the spots which proceed downwards to
the back &c, are not so distinct & prominent
as the others - these increase
in redness for two days, (ie) till the 6th day
or there about, when the 3rd Stage commences,
& the eruptions become brown
& dry, giving to the face a rough appearance,
and begin to fall off, in three days
more they totally disappear from the whole

226 
body, at this period the fever & cough
are sometimes alleviated, but more frequently 
increased, when it terminates
in a dangerous Peripneumony; the fever
will sometimes remit, & afterwards become
more violent. After this we must
conclude the Patient to be in very
great danger, unless some critical evacuations,
as increased Diaphoresis, an
abundant secretion of urine &c - occur.
There is some variety in this Complaint
but trifling, as the Eruptions appearing
in different parts of the body sooner or
later, also no desquamation taking place
when the disease ceases, & finally these bring
no eruptions, so that you would be unable
to distinguish wether it was Rubeola or not
unless you discovered an enquiry, that two or 
three of [cross out] the Patient's Brothers, were then labouring under
the Complaint - this species is very rare -

228
Rubeola Pariolodes - this form of Rubeola
is very rare - the febrile symptoms are if
the commencement the same as is Vulgaris,
but more violent, the fever being Synocha
at first & afterwards Typhus - coma generally
supervenes, but if it should not, then
will be a headache together with giddiness
or vertigo; the throat & fauces are
inflamed, the inf.n taking an a livid red-colour;
the stools are dark & fetid, and 
the Eruption is retarded, not appearing
before the 6th day of the fever; when it
appears thus late, it continues for a 
long time; the pulse is small & frequent,
the respiration is short & quick, with a 
shrill hoarseness & violent cough, in which
children appear almost suffocated, vomit
up their food & grow black in the face -
the eyes are red & watery; spasms - twitching
of the the tendons & delerium frequently

229
accompany Variolodes - also petechiæ, & 
swelling of the extremities - the fever increases
in violence together with the 
pulmonic symptoms, when the eruption
appears - till at last the Child expires -
in fortunate cases the fever abates or totally
ceases on the appearance of the Eruptions,
& the Patient recovers - Glandular swelling,
inf.n of the Lungs, consumption, Opthalmia,
& violent diarrhœa, will sometimes succeed after the
Child has recovered from the Disease, (ie)
when the Eruptions have ceased - Diagnosis
it is to be distinguished from Variola
by the Eruptions being much less elevated,
& by their being only what is turned papulous,
& not pustulous - from Varicella
by this complaint being pustular - I have
been mentioning the distinctions as alluding 
to both Variolodes & Vulgaris - but I have
omitted one, that they are always accompanied
by severe pulmonic symptoms, which distinguishes

230
this Disease from all others of the Eruptive
Kind - It was proposed to innoculate
for Rubeola - the advantage it was asserted
was, that if the Child by this means had 
the Complaint, it would not be accompanied
by any pneumonic symptoms,
& that it would soon recover, but this
assertion has since been found to be very
incorrect - the manner of performing the
operation is the same in innoculating
for the small-pox, only charging the lancet
with blood from the pimples instead of
matter; when on the 7th day the Child will
be affected - the only benefit w.h Dr. Tuthill
thinks we may derive from this is that
we are able to give the Disease to a Child
who is in perfect health & at an age when
they get through the complaint better -
this may be done in a much easier manner
& with greater advantage by exposing a child to the

231
contagion of Rubeola, under which another
Child may be labouring, in a very mild form
& this is an advisable plan - Prognosis -
When the fever is mild & vanishes on the appearance
of the Pimples - it will be favourable;
but if the febrile action is severe, the
inf.n of the fauces & chest violent, with coma
delirium, & receding of the eruptions, followed
by convulsions & petechiæ, the case is extremely
dangerous - The predisposing causes
are, that those who have never been affected,
are predisposed to it, also infancy, & youth
& a person of a plethoric habit of body is
liable to be affected severely - the Exciting
cause is specific contagion - Treatment -
we are governed in this by the fever & catarrhal
symptoms which are present. We
begin by giving an emetic of Ant. Tart or
Pulv Ipecac. followed by a purgative as Hyd.
Sub. which is to be worked off with Inf. Sennæ

232
then give saline draughts to act as
a Diaphoretic, the bowels being gently
Kept open - Bleeding must be had recourse
too if the febrile, & catarrhal symptoms
are severe, altho' it has been said
by some Practitioners, that we ought not
to employ blood-letting, untill other remedies
had failed - Dr. Tuthill thinks venæsection 
is on the safe side of the question
especially in adults. The application of cold
is not here indicated, but on the contrary
the temperature of the Patients ought to
be Kept at 65 dgs. The diet should be
a strict vegetable one - As the Eruptions
disappear saline purgatives must be given
at an interval of 48 hours - if debility ensues
after the E., & there is neither fever
nor pneumonia present, mild bitters may
be given - the Pulmonic inf.n if severe

233
is to be treated, by Bloodletting, cupping, 
Blisters, diaphoretics, purgatives & emulsions
with almonds & oxymell of Squills - when
extreme irritability seizes that alimentary
canal, producing a violent Diarrhœa -
venæsection will be requisite - In Variolodes
the bowels must be opened by a
mercurial purgative, & to alter the typhoid
state the Muriatic acid is to be 
given, but if it should disagree with
the Patient, then the diffusive as well as 
permanent stimuli must be had recourse
too. If delirium supervenes leeches are to be
applied to the temples. After the eruption
is completed slight opiates are sometimes
serviceable; the Patient should be directed
to drink of their watery acescent liquids,
as common fig drink, made agreeably and 
with lemon juice, apple water, current
tea, lemonade &c.

234
Class Neuroses
Order II. Adynamiæ.
The involuntary motions, wether vital or
natural, diminished.
Genus. XLIII. Syncope. Cullen -
Action of the heart diminished; or during
sometime suspended. 1st. Idiopathic
Syncope Cardiaca (arising from the heart)
often returning without evident cause,
vehement palpitation of the heart at intervals.
From some affection of the heart,
or its great vessels. Syncope Occasionallis
(nervous), arising from an evident cause
Derived from an affection of the whole system.
Symptomatic of diseases either of 
the system, or of other parts, the heart
excepted. Sir George Tuthill names another,
Syncope Anginosa - which differs
in some of the symptoms from Cardiaca

235
although on dissection we find the
same appearance; it is characterized
by pain in the region of the heart, with
stricture or tightness, pain extending up
the left arm to the insertion of the 
Deltoides, anxiety, difficult respiration
and returning at intervals. When Syncope
Occasionalis comes on gradually
it is preceeded by languor, anxiety, nausea,
giddiness, weakness of the pulse,
suspension of the hearts action, the 
face & surface of the body pale & cold,
a cold sweat breaks out on the forehead
at the commencement which continues
till the Patient recovers, during
the fit the animal functions are suspended.
After the action of the Heart
has remained suspended a little while
the Patient recovers when he is for a short
period quite stupified; but in some cases
Syncope terminates in Convulsions or 

236
Epilepsy. The Diagnostic symptom is
suspension of the Hearts action. Our Prognostic
is generally favourable, except
when Epilepsy or Convulsions succeed then
our Prognostic must be accordingly. The
Remote cause is divided into Predisposing
& Exciting with respect to predisposition,
we find persons frequently liable to Syncope
and it is conceived to proceed from an
extreme sensibility of the nervous system,
depending after an weakness. The Exciting
causes are Passions of the mind as fear,
grief, joy, also pain when it is sudden
as in spasmodic affections, likewise the
pain in Nephritis, or from a blow on
the testicle, from suddenly loosing blood,
and exceeding a certain quantity, from
long continued abstinence, from excessive
excretions, impure air when heated as in
crowded rooms, fatigue, poisonous exhalations,

237
exhalations, peculiar states of the stomach.
Dr. Cullen refers the Phenomena of fainting
to the diminished energy of the
Brain, which depends says he on a certain
tension & fullness of its vessels - this he
gives as a reason why evacuations of blood
produce Syncope, which he also says is
proved by this example - that if you bleed
a Patient sitting in a horizontal position
you will have to draw off a large quantity
before fainting is produced, but if
you bleed [cross out] him sitting upright then
Syncope will be soon induced - & the reason
he gives is this, that while the head is
in the horizontal position the specific
gravity of the blood keeps the vessels
of the Brain tense, but in an upright
position this cannot take place, consequently
the vessels become empty &
Syncope follows. Several other authors have
endeavoured to explain what occurs when this

238
Phenomena takes place. Dr. Tuthill conceives
their opinions as merely hypothetical. 
Treatment: Our object will be
first to ascertain the causes & afterwards to
remove them; for the latter purpose stimuli
may be freely used except when hemorrhage
occurs: they must be either external & internal.
The most approved of internal stimuli
are the Spt. Ammon. C. vel Fœtid, Spt. Succini,
Spt. Æther. Nitr. As an external stimuli cold
will be found very useful as cold water dashed
upon the surface of the body; also stimuli
to the Nose as burnt feathers &c and
friction of the temples. If Syncope Occasionalis
be symptomatic of other diseases as
Hysteria, Gout &c. the treatment must be
directed accordingly; where dependant on
morbid states of the stomach it may be
more readily corrected. Syncope Cardiaca
the particular symptoms of this have been

239
before described: the appearances on 
dissection are as follows: a preternatural
turgidity of the inner surface of the Heart,
& its vessels near their commencement; also
organic changes of the substance of several
parts; aneurismal swellings of the Heart, & of
the arch of the Aorta both ascending & descending
portion: Ossification of the valves
of the heart & of the Aorta: Hydatids: adhesions
to the Pericardium: calculus concretions:
from these different appearances we are led
to conclude that this malady is always
dependant on organic change, and whatever
contributes to impede the free action
of the Heart favours its production. The
Exciting causes: such as determine the blood
to the more internal parts. as well as that
which suddenly produces vascular plethora,
also whatever increases quickly the
hearts action. Diagnosis: frequent faintings
with freedom during the intervals. Prognosis

240
irremediable & always dangerous. Syncope
Anginosa: consists of paroxysms
the Patient begins by complaining of pain
suddenly across the Chest extending up the
left arm, with a sense of suffocation, the
countenance is anxious, & the Patient has an
idea that life must soon terminate, the
breathing is laborious, the pulse intermitting,
but the action of the heart and
lungs still continue, & are not so completely
suspended as in true Syncope: this paroxysm
may last 2. 3. or 4 minutes but seldom longer,
altho' it does occasionally. The malady is at first
brought on by the Person exerting himself in
some way, so as to impede the free action of
the respiratory organs, which may often
be increased by violent passions of the mind:
when the disease is further advanced the Patient
cannot move without bringing on
a Paroxysm. If the Person remains quiet

241
during the first period of the attack, it will
generally cease, but in the further progress
of the disease this will be of no avail - during
the Paroxysm the face becomes pale
& the extremities grow cold, the lips being
at the same time livid, or of a purplish
hue. Diagnosis: by the symptoms described
in as much as they resemble no other malady.
Prognosis: highly unfavourable. Appearances
on dissection. Ossification of the heart or its
valves, & of the Aorta it is often aneurismal
both its ascending & descending arch;
Ossification of the coronary arteries. The
Exciting causes, are all that materially
influence the heart's action, whereby such
change is produced. Treatment - This is reckoned
an incurable disease, tho' we may
use palliatives - when it arises from Plethora
bleeding may be practised, afterwards
pursuing a strict antiphlogistic
plan, & regular exercise: when organic disease
exists issues must be had recourse too & repeated

242
blisters: when we all able to ascertain
the presence of Hydrops Pericardii, we must
employ those remedies which have a tendency
to promote the absorption of the fluid,
When the complaint is Known to depend
on organic change, it is extremely doubtful
wether anything can be of ultimate service.
Dr. Parry, who has written a work expressly
upon the subject, recommends frequent
& small bleedings: stimulants & antispasmodics:
the Patient is to be carefully taught
to avoid the exciting causes in order to prevent
its return. Purgatives are sometimes
useful. To strengthen the system we generally
employ stimulants & tonics of the Nitrate
of Silver. Issues in the thigh have
been recommended. The Patient should abstain 
from all fermented liquors, & eat
but little at a time. If there is a tendency
to increase in bulk, use moderate exercise
the bowels are to be Kept gently upon and

243
no morbid accumulation allowed to remain
or take place.
Genus. XLIV. Dyspepsia. Cullen -
Loss of appetite; nausea; vomiting; flatulence;
eructation; rumination; heartburn;
pain of the stomach; at least having
some more or less of these at once;
mostly with costiveness; and recurring
without disease of the stomach or other
parts. 1. Idiopathic. 2. Symptomatic
1. From disease of the stomach. 2. From
disease of other parts. This complaint is
very slow in its progress; the Patient often
not perceiving its approach; he perhaps
eat less than usual, & begins to feel a
fullness after eating in the region of
the stomach, after a time he experiences
this troublesome sensation without having
eat anything; he is much relieved by the 

244
by the expulsion of wind - there is a frequent
chilliness once the whole body, the
sleep is disturbed: when the disease has become
more advanced slight & transient pains are
felt in the region of the stomach; the countenance
looses into natural cheerfulness,
there is nausea which in some instances
amounts to vomiting; eructation & a burning
Kind of a pain in the stomach; the
complaint in this stage may last for weeks
or years, but it is generally soon attended
with other symptoms, dependant on the weak
& reduced state of the system: the pulse is
sometimes slow, at others full & quick; easily
accellerated by exercise; palpitations become
frequent; the bowels are confined;
the passage occasioning a rumbling noise;
after eating the tongue becomes white,
the face is flushed, skin hot & dry, these symptoms
remain untill the food passes the
Duodenum and sometimes the animal 

245
functions begin to suffer; the Patients
vivacity forsakes him; he is in capable of exertion
& seeks retirement, & finally becoming
quite Hypocondriacal. On dissection we find
no symptom of disease; that is when the
complaint is Idiopathic. Your Diagnosis is
formed from the symptoms just enumerated.
Your Prognosis will always be favourable,
altho' the cure will often be protracted
& difficult. The Proximate cause is accounted
by Cullen to be want of power
in the muscular coat of the stomach,
but on the contrary it has been very
generally considered as proceeding from
the morbid state of the secretions as the
Gastric in Pancreatic juice &c. The Predisposing
& Exciting causes are those
which when applied to the stomach induce
the malady, as Opium, Ardent
spirits, which tend to debilitate the stomach,
also warm weakening fluids frequent

246
drank; the habit of spitting; defective
or vitiated secretion of saliva or gastric
juice; & frequent vomiting. Those causes
which act primarily on the system are
a sedentary life & indolence; the depressing
passions of the mind; constant mental
application; repeated intoxication these
will immediately or ultimately produce
Dyspepsia. Treatment. The main circumstance
which here directs our treatment
is the Proximate cause, therefore we must
begin by endeavouring to restore the muscular
coat of the Stomach to its healthful
state according to Cullen, but according
to others by producing healthy secretions.
In the first place we must resolutely
insist on the Patients according the exciting
cause. What greatly tends to aggravate 
the symptoms are noxious in materials in
the stomach, which we must get rid off

247
by giving an emetic as Pulv. Ipecac 2j
or Ant. Tart gr ij or Pulv Ipecac gr xv Ant Tart
gr 1. many Practitioners are in the habit
of repeating emetics, but Sir George condemns
this practice, as tending to debilitate
the stomach & prefer giving only
a single emetic at first, then using other
remedies to remove the train of symptoms
which are present viz. the morbid acidity
by Alkalies as gr xx of Carbonate of Potash
or Soda; the heart-burn will also be relieved
by the above means - the dose
& frequency to be regulated according
to the degree of acidity present: if costiveness
prevails gentle laxatives must
be given as Magnesia ʒss daily. Carminatives
are sometimes useful as
the Black pepper in doses of gr x or Cyan
pepper. Creta prop. combined with Magnesia
is sometimes given in cases of acidity especially
when it produces diarrhœa or we

248
may give the Pulv. Cræta cm Opio -
For flatulency we employ the Mist Carminative
of the London Pharmacopæia:
for spasms Camphor, Musk, Opium &
Other as antispasmodics, also the warm
bath; the remedies I have mentioned are
used as palliatives only; but in order
to restore the tone of the stomach we
give Gentian, Quassia or Calumba on doses
of ℥ij; after the Patient has taken this 
sometime, preparations of iron may be
combined with it. Another remedy
which is often made use off with considerable
benefit, especially when the
disease is dependant on a morbid state
of the secretions, or organic derangement,
is Mercury in alterative doses 
as Pil Hydraeg gr v every night, with Infus
Crassiæ ℥ij Potass. Carbon. gr xx ter in Die -

249
A meat diet is to be prefered to a
vegetable one; exercise on horse-back;
the cold-bath; rising early & going to
bed soon; the chalybeate waters, and
finally the Patient regulating his clothing
according to the vicissitudes of the weather.
Genus XLV. Hypocondriasis.
Cullen. Dyspepsia with languor; dejection
of the mind; and fear arising 
from trifling causes, in persons of
melancholic temperament. This malady
says Sir George commences with
the Patients loosing his activity & cheerfulness,
attended with invincible languor,
a settled sadness, & foreboding
what is to happen to himself - if he
is a Merchant, he conceives his affairs
to be in a distressing situation, & takes
the worst possible view of future events -

250
The slightest accident appears to him
a great misfortune; he takes a great
care of his health; all the Patients symptoms
are greatly magnified by himself;
there is certainly a degree of pain but
this he fancies to be much greater & of
more importance than it really. This
disease is always blended with Dyspepsia,
& sometimes combined with symptoms
of Hysteria as the shedding of tears, w.h
sometimes occurs in this complaint. Some
Authors have asserted that it is similar
to Hysteria. Hypochondriasis occasionally
ends in Melancholia; as the disease
advances the Patient is affected with
dizziness, dimness of sight, palpitations
of the heart, paleness of the urine, pains
in different parts of the body - the diseased
states of the liver & spleen are favourable

251
favourable to Hypochondriasis. The
Proximate cause is not well understood,
but supposed to have its origin from the
organs of digestion. The Predisposing causes
are Dyspepsia; only attacking Persons
at certain periods of life as the middle
period. The exciting cause is also not exactly
known, but all the causes by which
Dyspepsia is induced may bring it on -
Diagnosis. It is sometimes confounded
with melancholia or Hysteria, it is to be
distinguished from the former by the
dyspeptic symptoms; from the latter by its
not occurring at an early period of life,
by its formation being more gradual,
& by its being unaccompanied by the
globus hystericus; it is to be distinguished
from other disorders by the mental affection,
& by its increasing as life advances.
Prognosis. When the malady is recent it may 

252
be relieved, but if it has continued
for a long time, accompanied by organic
disease your Prognosis will be very unfavourable,
yet, if after a careful examination
you discover no organic change,
then you may conclude it arises from
a disordered action, which may very
probably by proper remedies be relieved.
Hypochondriasis may last for a month, a
year or a year & a half and yet the Patient
recover. Treatment. We must here especially
endeavour to relieve the gloomy
apprehensions & fears of the Patient and
the Dyspeptic symptoms, for this last we
may employ the remedies mentioned under
the head of Dyspepsia, but besides
these it usually requires alterative
medicines, especially when there is organic 
change as Pil Hydrag gr v every night 

253
with Infus Calumlæ ℥ij Potass Carbon
gr xx ter in Die, at the same time to allay
any nervous irritability you may give
a class of sedatives as Camphor & Hyoscimus
āā gr v ter in die - this need not
at all interfere with the other medicines.
It is to be remembered that your 
object here is not to produce salivation
therefore if the mercury tends to do so
you must diminish its dose or let there
be a longer interval between each	
dose. Attend particularly to the alimentary
canal, but drastic purgatives
are not here required, only give
Ext. Rhæi gr v combined with the Pil -
Hydrarg, so that the Patient may have
a stool daily. The secretions in the bowels
may sometimes require a stronger purgative.
The Diet must be light but nutritious.

254
nutritious. There is present in this malady
a disordered imagination. Gain the confidence
of your Patient if possible for
that will assist most materially in effecting
a cure. In gaining your Patients
confidence, you must pretend
to believe that what he informs you off
is real not imaginary: arguments here
are useless. Although he may seem determined
not to be convinced of anything
favourable as to his complaint,
still if you should seem to favour his
opinion of himself, he will be highly dissatisfied 
with you, as during your absense
he revolves what you have said
over in his mind; therefore it is very necessary
you give an attentive ear to his
complaints, & acquaint him that if he 

255
will take your medicines regular,
you have no doubt of his recovery. It
is important likewise to give him some
pursuit or employment, but not such
as will bring his fortune into stake
or those which will produce mental
anxiety or fatigue; engaging in field
sports, and travelling about so as to vary
the scene will be highly beneficial -
If any one of these pursuits engage his
attention, his cure is certain - the exercise
that he takes ought to be principally 
on horse-back - You must be
careful not to allow your Patient stimulants
as wine, spirits or Opium, which
persons labouring under this malady
are very prone to take, as they will
in time produce the most pernicious
affects. Sir George relates a case of a Gentleman

256
Gentleman who is now able to take (from
the long continued habit of many years)
half a pint of Laudanum-
Genus XLVI. Chlorosis. Cullen -
Dyspepsia: desire to eat things that are
not nutritious; paleness or discolouration
of the skin; defect of blood in
the veins; the œdematous swelling of
the body; debility; paleness; retention
of the menses. The principal feature of
the disease is the last mentioned symptoms,
of which there are two kinds chronic
& acute, the former arising either
from Plethora or weakness. You are 
I presume well aware that the Menses
appear in this Country from the age of
14 to 16 years, and ceases between 40 & 50-
but from a morbid disease of the vascular

257
vascular system it commences sometimes 
at 10 years when it will be accompanied
by headache, dizziness vertigo &c, which
symptoms are to be relieved, (if the Patient
is 11 years of age) by taking away 16 ℥ -
of blood & afterwards to give a saline
purgative; but what more commonly
is that the menses are delayed & are
later than usual as to 18 or 19, this depends
either on weakness of the constitution, 
disease of the Uterus or
scrofula. Another Kind of case is after 
it has once begun it may be obstructed,
this may be either acute or chronic;
by the former is meant a sudden
suppression, or the Patient having the
day before felt herself very unwell catches
cold - this will be accompanied by febrile
symptoms, the tongue will be white 

258
an universal languor, pain in the
head, pulse quick as 110 & other signs of
Pyrexia. Our remedy here also is depletion:
take from 8 to 10 ℥ of blood, afterwards give an
Emetic as Pulv Ipecac 2j after this has
ceased to operate, a saline purgative must
be taken, then the common diaphoretic 
draught & placed in a warm
bath, by these means, (if the Patient has
had recourse to medical aid as soon as she
was attacked) the disorder is cured, but
if she has neglected herself it goes into
a chronic case of obstruction with Plethora
or weakness, the symptoms which
then accompany it are, drowsiness,
shortness of breath, dizziness, thirst,
pulse 90 to 100, great restlessness in bed
or out; to reduce the plethoric state to the
level of health, stimulants have been 

259
used by some but these are full of
danger; our plan is depletion from 8 to 10 ℥
& then purge with neutral salts daily,
& topical bleeding may be resorted too
after the first general bleeding, as leeches
or cupping glasses to the head & chest.
The true chlorosis is chronic obstruction
from weakness, although from plethora
generally terminates in weakness; when
the Patient grows weaker, there is a
yellowness of the countenance, a desire
to eat things that are not nutritious,
Dyspepsia, & edamatous swelling of the
body - as that of the ancles; the veins have
a particular blue appearance; the respiration
is difficult, which is increased by
walking quick or going up hill, and is also
attended with pain in the side; the
digestive powers are considerably weakened
& impaired; pains & throbbing in the head

260
the pulse is generally 100 but increased
by exercise to 110 - 20 - or 30; there is sometimes
so great on irritation of the nervous system
as to produce Hysteria; the menstruation if
there is any gradually becomes less & at greater
intervals, also paler till it gradually ceases.
True chlorosis has several graduations, as
to the quality of the secreting fluid, which may
deviate from that of health in being serous,
watery &c, in being suddenly or gradually suppressed.
The Proximate cause is suspension
of this natural secretion. The predisposing
& exciting causes are on the whole little understood,
but supposed to depend on peculiar 
states of the nervous system, but what
those states are, is unknown. Your Diagnosis
is easily formed. Your Prognosis, if the complaint 
is recent, will be favourable, & at
a later period if it has induced no other
malady it will likewise be favourable,
but where it has produced some other complaint,

261
complaint, then our prognosis will be accordingly.
Treatment. Our main object here
will be to strengthen the Patient by improving
the viguor of the stomach, & removing
extraneous & noxious matter from it,
which is done by the exhibition of an emetic
as Pulv Ipecac 2j vel Ant. Tart gr ij, by this
we exert great power over the uterus, from
the great sympathy which is known to
exist between the stomach & that organ;
the Patient is then to be purged with
Calomel & Rhubarb; bitters must afterwards
be given combined with gentle aperients,
but they must be at first weak & adapted
to the strength of the Patient, & gradually
be made stronger; we may commence
by giving the Infus. Anthemidis vel Chamomille
℥ ij Pulv Rhæi gr v ter in Die, the quantity 
of Rhubarb must be sufficient to produce
three motions in 48 hours; after she has taken
this a little while we may give the Infus -

262
Quassiæ, & afterwards Chalybeates as Ferri
Sulph gr i to each draught of the bitter, gradually
increasing it to ij vel iij grs or the Mist.
Ferri or the Pil. Ferri cm Myrrh; we may give
likewise those purgatives which stimulate
the lower extremity of the gut, that is, the
Rectum, which from its proximity to the
Uterus, may excite it - for this purpose we
give the Pil. Aloes cm Myrrh either alone or
combined with the former Pill as of Pil Aloes
cm Myrrh. 2j Pill Ferri cm Myrrh. 2ij Mist et
divide in Pil. N. oxij Cap.s ij ter in Die. Whilst
we are pursuing these means the Patient
should have change of air & exercise, more
especially on horseback if it can be borne. 
By these remedies you will contribute to
restore the strength & general health of
the Patient; but if depletion in the first,
& these medicines in the latter, have been
used; and she still does not menstruates,
{pernicious that by their use the Patient 

263
strength is restored) we employ those
remedies which have a specific action over
the stomach but chiefly the Uterus - as R.
Savin. vel R Hellebor. Niger. gtt xx vel gtt xxx prodor,
using at the same time the warm hip
bath at 100 degrees for 20 minutes every night
before going to bed; electricity has been
recommended by some writers, but Sir
George thinks it a very uncertain remedy
& from his own experience says that if it
does not produce benefit at first it will
not by its frequent repetition - the manner
in which it is done is by passing
gentle electric shocks through the
uterus. Issues & Madder have also been
recommended, but I never knew them
says Sir George produce any beneficial
effects - Order III. Spasmi: Cullen
Irregular or preternatural motions of the
muscles, or muscular fibres. 1st. In Functionibus animalibus.

264
Genus. XLVII. Tetanus. Cullen
Spasmodic rigidity of muscles. It varies. a. in
degree; the half or whole of the body being effected
with spasms. It differs, b. in its remote
cause, arising either from internal cause;
from cold; or from a wound. c. in the part of the
body effected. Spasmodic contractions are of
two Kinds, that which is of long duration &
is called Tonic Spasm. but that which is sudden
and rapidly followed by relaxation, and these
relaxations & contractions are frequently renewed
is turned Chlonic Spasm a famiilar
example of the former is Tetanus; of the
latter is Chorea Sancti Viti. When this disease
comes on gradually, the symptoms are as follows.
The neck at first becomes rigid &
immovebale, afterwards by strong spasms it
is drawn either backwards or forwards, an
uneasy sensation is felt at the root of the
tongue; the spasmodic rigidity now extends 

265
to the lower jaw, the motion of which
& the act of swallowing are impeded; as
these symptoms continue to increase, a pain
is felt at the inferior part of the ensiform
cartilage, which strikes through to the 
spine, the Patient is not able to open his
mouth, the spasm under the breast bone
is frequently renewed, & its presence is
followed by excessive pain; this part of the
complaint is Trismus - afterwards he is able 
to open his mouth only partially, and the
muscles of the back become affected, by 
which the body is either bent forward
or backward, if the former it is termed
Emprosthotonos, if the latter Opisthotonos,
shortly after this the muscles of the lower
extremities are effected, & drawn into
similar action, the legs are generally extended
to such a degree, that they cannot
be bent back, & the flexor muscles of the neck
will often balance the extensors, & at last the

266
body grows stiff & appears like a piece of
wood, at the same time is completely straight
& rigid - the muscles of the abdomen will sometimes
be effected & the body in consequence
drawn forwards, at length the upper extremities
suffer under similar action;
the tongue either grows rigid or else is
convulsively thrust out if there is an opening,
the jaws at the same time contracting,
it is very much injured; when the
spasms are violent, most acute pains come
on, the face is red & distorted, the cheeks
are drawn backwards, the eyes fixed, the
pulse is most frequently slower than what
is natural, & should blood be taken, its
texture appears to be less firm, then is sometimes
much difficulty in respiration, & the
body is costive. The natural actions are not
suppressed, & the senses both external &
internal remain perfect, the ribs cure 

267 
inwards - and if the disease should be
conquered, the Patient continues a long time
in a state of great debility, but in general
convulsion ceases the whole frame, & puts
a period to his existence. There is a short
remission of the spasmodic attacks at an interval 
of ten minutes, but not so as to
allow the antagonist muscles to act or
the body to be bent; there is nothing which
can be called fever in this complaint,
often a morbid hardness of the pulse which
seem to be effected by a convulsive action.
Our Diagnosis is very easy. Our Prognosis
is generally unfavourable; when Tetanus
arises in consequence of an injury the
symptoms are ascribed by some writers
to be more violent, & the cure more difficult,
than when it arises from other
causes; when the Disease comes on suddenly
the Patient usually dies on the 4th day, but if
the case is a protracted one, that is, lasts for 

268 
a fortnight, your Prognostic will be
favourable as the Patient may recover; when
persons die of this malady they are in general
soon cut off. I caution you Gentlemen says
Sir George to be on your guard of giving
a favourable prognosis of the event from
the Patients appearing much better on that
day, as this is very fallacious, for most
probably & it often happens that the unfavourable
symptoms return again with
increased violence the next day. This disorder
admits not of a sudden or critical
resolution, but recedes gradually; when
it is only partial it subsides without
danger but when the spasms affect the
neck & jaws, the danger is great, but not
to great as when the other voluntary muscles
are also effected, for then the danger
is imminent. Nothing has been discovered

269
post mortem which would lead us to
pronounce its Proximate cause, although
we conclude that it is the effect of a 
morbid or preternatural irritation of the
nervous system - With respect to predisposition,
this complaint may happen from
certain exciting causes in every country,
but in some more frequently than others,
as oftener in warm climates than cold ones,
& with us it occurs oftener during the 
warm season than the cold; not happening
in childhood or very old age, but
is considered a disease of manhood and that
it is more particularly incident to males has
been asserted by some writers, this Sir 
George Tuthill thinks arises from their 
being more exposed & subject to the exciting
causes; it generally effects the
robust, seldom attacking the weak & delicate.
What predisposes to it is as little known

270
as the proximate cause. Exciting causes -
the most frequent of these are ascertained
to be injuries done to the nerves, which
most commonly happens to the extremities
as the hand or fingers, & the foot or toes,
but Dr. Tuthill mentioned having seen a case
where it occured in consequence of injury
done to the nose, this is a rare occurrence;
it arises sometimes from injuries of the
head & trunk, produced by punctures, lacerations,
contusions, & fractures where the
spiculæ from the bone has injured a nerve,
also from the division of a nerve, from fixing
of an artificial tooth, & from amputation.
When this complaint occurs in consequence
of an injury, it does not come
on for several days after the wound has been
received, & sometimes even after it has healed,
this particularly happens in the West
Indies. The other cause is cold produced by 

271
moisture as by laying on the ground when
it has been damp; by wearing wet clothes
&c. As to the Treatment, there is nothing satisfactory 
that I can lay before you, for
when Patients have recovers from the use
of particular remedies & medicines, it has
been doubtful whether this recovery is to be
attributed to the remedy employed or not
as when it has been given in similar cases
it has been unsucessful. If a nerve is
lacerated our practice will be to divide
it, if any foregin substance as a spiculæ of
bone, it must be extracted, if it arises in
consequence of the nerve being tied in amputation
it must be disengaged, if
from Pus under the tendinous expansion
of a muscle, it must be let out.
If we are able to remove the exciting
cause the Patient may recover. If it arises
either from external injury or cold we
can only act on the general system -

272
It must be our endeavour to destroy the
morbid action of the nerves, for which the
principal remedies are cold effusions, Alcohol
Opium, Mercury & Blood-letting; with
respect to the first, the experiments made
with it in this Country, when it was first
introduced, were singularly successful; they
were made at Liverpool by the late Dr. Currie
on a soldier of the name of Gardener, who
this Gentleman relates had been to a Duke
and on returning home at night felt himself
drowsy & laid down on the cold ground
& fell asleep, in consequence he was seized
with Tetanus; the medical officers in their
treatment gave him at first Mercury in doses
so as to produce an abundant salivation,
from which the Patient not deriving any
benefit, Opium was restored too & given in
very large doses, so as to produce a temporary
paralysis, this also gave no relief to

273 
the Patient & he having already remained
in this state for more than a fortnight,
they consulted Dr. Currie on the case, who after
he had seen the soldier ordered cold effusion, (he 
having read in some publication of its having
been tried in America with success) which 
was accordingly performed on him, by plunging
him during the spasm into the cold
bath at Liverpool, by which the spasms appeared
a little abated, & it was thought advisable
to plunge him in a second & a third 
time, when taken out he appeared nearly
dead, but received in a little time and
seemed to be better; he was now ordered
to be put to bed, where he remained
four hours, after this great was the surprise 
of the medical Gentlemen to
see him walk out of his bed, apparently
quite recovered. Opium is the favorite
remedy in this disease, but recommended
to be given in large doses, although some

274
are of opinion that if given in smaller
doses frequently repeated, it will act with
greater efficacy. Opium gr I every two hours
his strength to be supported at the same
time by moderate quantities of wine &
a nutritive diet. It has been concluded by
some writers that the Patient dies in consequence
of want of stimulous, therefore
they recommended giving wine in large quantities
so as to produce intoxication, for
which purpose they also gave alcohol -
When the remedies above mentioned as cold
affusion, Opium, wine have any effect
it is protracted cases; as in the case of
Gardener Sir G. Tuthill is of opinion, that had
cold affusion been used in the early stage
of the disease, it would not have succeeded.
Blood-letting in large quantities has been
practiced in this complaint but more abroad
than at home, & it has been asserted

275
that if Blood be taken away in as large
quantity, as it can be done with safety to
the support of life, it will put a stop to
& cure the disease; & the manner in which
it acts is by relieving the system by removing
the noxious matter from the circulation -
this appears to be erroneous 
as Tetanus does not arise from noxious
substances in the circulation, but from
nervous irritability. Dr. Tuthill does not
recommend this practice, and from Mercury
he has never seen any benefit accrue
or from Musk, Camphor, electricity &c. 
this says he is a disease in which no
mode of cure has been considered as
ascertained to be a desideratum -
Genus XLIX. Convulsio. Cullen
Irregular contraction of the muscles; without
sleep. 1st. Idiopathic. 2nd. Symptomatic.

277 
Genus L. Chorea. Cullen.
Affecting young persons especially from ten
to fourteen years of age; with convulsive motions,
partly voluntary; for the most part of one
side; the motions of the arms & hands resembling
that of players; in walking one foot
is rather dragged than lifted.
Genus LI. Raphania. Cullen
Spasmodic contraction of the joints; with
convulsive motions; & very violent pain which
is periodical.
Genus LII. Epilepsia. Cullen
Convulsion of the muscles with sleep. 1st Idiopathic.
Epilepsia Cerebralis (from the brain)
suddenly coming on without any evident
cause; unpreceeded by any troublesome sensation;
unless sometimes of vertigo, or dimness
of sight. 2nd. Epilepsia Sympathica (sympathetic)
without evident cause; but preceeded

278
by the sensation of a peculiar aura rising
from some part of the body to the head.
Epilepsia Occasionalis (occasional) arising
from evident irritation, & terminating when
that irritation is removed. This varies from
the difference in the irritating cause. a. From
injury done to the head. b. From pain. c. 
From worms. d. From poison. e. From cutanerous
eruptions or acid humours being repelled.
f. From acidity in the stomach. g. 
From affections of the mind. h. From superabundant
hæmorrhage. i. From debility. 2nd.
Symptomatic. 3rd. In the vital functions.
In the action of the heart. Several diseases
which consist in rapid alternations of relaxation
& contraction, are termed Convulsion.
The four diseases of this kind which belong
to this class are nearly allied to each other
Raphania consists of partly chlonic and
partly Tonic spasm, is known by a quick 
morbid contraction of Muscles without the
consent of the will. Chorea. It is remarkable 

279
that untoward actions which occur in this
complaint are often irritated by persons
especially children, untill from continual irritation
they experience in reality those
convulsive motions in a slight degree, which
gradually increases, & at last becomes a confirmed
Chorea. The general health is not
at all effected in this complaint. As a partial
affection it often attacks children about
10 years of age. It is first observed by the Child 
dragging the left leg after him in walking, after
a little time the hand of the same side becomes
effected, & the Patient when he wishes
to raise his hand to his mouth, is unable
to do it untill after repeated trials, it being
by spasmodic action drawn away in a different
direction. Sir G. Tuthill does not agree
to the operation of some writers that the
health is not effected in this disorder, & mentions
that it is in some degree effected; that the
muscles of the side effected waste, & if the 

280
complaint attack both sides, then they
are similarly effected, the urine is pale,
bowels constipated, digestion imperfect, little
or no fever; sometimes the muscles of the
larynx, pharynx & tongue became effected
when there will be difficult deglutition, dyspnœa,
& the tongue thrust frequently out of
the mouth, & the spasmodic action of the jaw
taking place at the same time, it is often
caught and injured, the muscles of respiration
are often affected. Chorea is preceeded 
with only a short morbid state of
the system; its denotation after it has
once formed is uncertain, as it may
continue for weeks or months. The Operations
of the Mind are apt to be effected
in this disease, & the Understanding seems
to suffer from some fatuity, & the mental
powers appear to diminish Raphania.
In this affection the Muscles are
not only convulsed but effected with Chlonic

281
spasm, this disease does not often occur
in this Country the symptoms have seen
before described. Epilepsia is attended with
chlonic spasm of the muscles attended with
insensibility & sleep; always making its appearance
by fits; attacking Persons apparently 
in health & returning after the fit
is over, the duration of which is uncertain.
Often previous to an attack certain symptoms
give notice of its approach to those accustomed
to Epilepsy, sometimes no symptoms
except a momentary giddiness give the Patient
warning its approach. The symptoms which
frequently announce it are giddiness, a pain
in the head, ringing in the ears, inability
to sleep, frightful dreams, unusual drowsiness,
palpitations of the heart, weariness
& stupor, and more particularly the Aura
Epileptica, which some Persons describe, as a 
sensation of something coursing in a part of
the body, & at length reaching the head, when 

282
the Patient falls down in a fit, others
describe the sensation as that of vapour
very cold in one of the legs, which gradually
extends up to the head; others like the sensation
of a small insect creeping up the 
body to the head; and others like the sensation
of a stream of air ascending up the body
to the head; now either suddenly or preceeded
by these symptoms the fit takes place, &
the Patient falls down insensible, and when
down the voluntary muscles are much affected
with chlonic spasms, especially those
of the face & eyes, which are greatly distorted,
while these symptoms continue, a 
frothy moisture issues from the mouth
& the face is tumefied; sometimes these
spasms remit & are again recurred,
after which the Person is overcome with
sleep, & when he awakes has not the least
recollection of what has occurred, the pulse 
& respiration are rather humid during the fit 

283 
The symptoms vary much in degree in 
different cases; most probably the Fit will
return, but the internal which will elapse
between each is uncertain, as some are attacked
every week, others once a month or a year,
the longer the interval the milder the disease.
Epilepsy will sometimes occur with movements
similar to volition, as he will run his head
violently against the wall or floor of the room
striking them with his hands, or appear
to the spectators, as if he wished to do some 
violence to himself. It often impairs the understanding.
Sometimes the spasms do not
cease when the Patient has recovered his senses. 
Persons afflicted with this disease usually die of
Paralysis or Apoplexy. Sometimes in Children
when it has resisted all medicines, it will of
of its own accord disappear at the age of puberty.
In the examination of Patients after death
nothing satisfactory has been discovered which 
would lead us to suppose what was its Proximate cause.

284
It is not probable there can be any organic 
change of structure in the Cranium, from its
happening in some Persons only once in three years
and perhaps lasting as many minutes. Sir
G. Tuthill supposes it must be some extraordinary
& tempory change taken place in the
centre of the nervous system. If in Epilepsy
post mortem we find effusion & turgescence
in the cavity of the Brain, it is very doubtful
but that it is the consequence of Apoplexy
into which this complaint often terminates.
Your Diagnosis from the symptoms which
I have described will be easy, of Chlonic
Spasm. Your Prognosis in Convulsio depends
on its duration, that is, if it has effected on
Patient at intervals for many years it will not
be in the power of medicine to effect a
cure, but the Patient may possibly get well
by mental exertion in some way. In Chorea
Your Prognosis is favourable, except when it runs
into Epilepsy. Children if attacked with any 

285
kind of Convulsio generally recover. Epilepsy
is the most dangerous of these diseases; if it
should occur at the age of 25, & the Patient never
having had an attack before, he will never 
be cured, although if there is a long interval
between the fits, they will not much interfere
with his comforts, but if on the contrary they 
are frequent, they will either destroy the
Patient, or greatly impair his understanding.
If it arises in Children from teething, it soon
disappears when the exciting cause is removed
that is, when the tooth protrudes thro' the gum.
The Proximate cause is supposed to be a peculiar
state of the nervous system. With
respect Predisposition, young Children are more
liable to it than those arrived at the age
of puberty, & also similar diseases occurring
in their Parents which are hereditary & termed
Nervous, likewise Epilepsy, Convulsion &c. predispose
to this complaint, likewise an excessive
irritability of the nervous system predisposes
to Chlonic spasm, & another state is weakness

286
however induced, as for instance has been
weakened from excessive Hæmorrhage convulsions
generally succeed death. Sleep also & a Plethoric
state of the vascular system predisposes
to it. The Exciting causes are all
those that can produce sudden excitement
in the Brain wether acting directly
or indirectly, of the former as mental irritation
produced by Ossification of the Brain,
splinters of bone in the skull from fracture,
from overdistention of the vessels of the Brain,
the indirect causes are teething, worms
& other noxious substances in the alimentary
canal of Children; all that can materially
weaken the system, depressing
passions of the mind as horror, grief &c;
diseased states of the Heart & Arteries
& also are sometimes accompanied by chlonic
spasm; likewise pregnancy; extraneous
bodies lodged near nerves may produce
such local irritation as is followed by convulsions,
disordered menstruations pain, fever &c.

287
In heating these diseases, the main feature
is the morbid action of the [cross out] muscles
except in Epilepsy where it consists in the
insensibility. Our endeavour must be to
remove the exciting cause, & alloy the irritability
of the nervous system, if it arises
from injuries of the head, such surgical
treatment must be adopted as to relieve the
symptoms, which will be done by first ascertaining
the nature of such injuries, in 
Children as the exciting causes are generally
in the alimentary canal or the gums, if 
this last they should be lanced, if the former
removed by purgatives, and during
the Convulsions placing the Child in a warm
bath at 100 degrees for about twenty minutes.
Chorea. this disorder Dr. Tuthill thinks arises
primarily from the alimentary canal,
therefore recommends purgatives of the drastic
as most excellent remedies to be repeated

288 
either daily or every other day as to a child
from 10 to 14 years of age Hyd. Sub. gr ij Pulv
Scammon. C. gr x ad xx, if the mouth becomes 
effected, you must stop the exhibition of
Calomel & give the Scammony alone; continue
this treatment a week, & if by that
time the Patient has derived a manifest
benefit, you may then decrease the purgative
to every other day, whilst the disease
continues to amend, but if you find instead
of improving it becomes stationary,
it then requires the aid of minerals
as the Nitrate of Silver gr I three times a
day, which is to be gradually increased
to gr iij, if you give instead of this Oxyde
of Zinc the dose of this will be gr ij ad gr iij
ter in Die or gr ss of Sulphate of Zinc
these may be given in pills. The Purgatives,
during the exhibition of the above minerals,
must not be given with the same frequency
as before. In Epilepsy of the Patient is 

289 
robust & of a plethoric habit, we may
commence our treatment during the fit by
bleeding him either from the arm or jugular
vein, & taking away such a quantity as will
relieve the Patient's turgescency; but where the
Person is of a Caxhetic or weak & debilitated habit
of [cross out] body, bleeding is not necessary but we
must give antispasmodics both by the mouth
& by injection, cold must be applied to the head,
& Tr Fœtid, vel Spt. Ammon. Fœtid a tea-spoonful
given in a little water, during the paroxysm
also Musk. Opium & Æther are recommended
& the Lin. Ammonia to be rubbed on some part
of the body, if the fit continues, we must introduce
a flexible gum [cross out] tube into
the œsophagus, through which introduce the medicines;
in our treatment of the plethoric Patient
I forgot to mention that the diet must
be of the antiphlogistic Kind. After a fit
has passed, you must adapt your treatment
according to the nature of the exciting cause 

290 
if Plethora exercise & low diet, & where
then there is much vascular action, bleed-
if weakness, give antispasmodics as before mentioned
& Bitters as Peruvian Bark also the 
Mineral tonics as the Nitrate of Silver, Zinc,
Iron & Arsenic, the cold bath nutritive diet
gentle exercise, the Pil Galban C. Musk
Castor, Æther; when the fit is just approaching
it is sometimes prevented by anything
w.h will produce considerable action in the
system as an emetic of Zinci Sulphas; if 
the Patient is affected with the aura epileptica
in order to prevent it ascending up to the
head or ligature must be tied above. The
Ol. Terebinth has been recommended in 
Epilepsy in doses of ʒij to ℥ss -
In Functionibus Vitalibus
Genus LIII Palpitatio. Cullen
Vehement & irregular motion of the heart.
Palpitatio Cardiaca. almost constant, at
least often recurring without evidence.

291 
Palpitatio. Dr. Tuthill terms this Chlonic
spasm of the heart, which is characterized
by a fluttering & beating in the left side of 
the breast, is not constant but occurs by 
paroxysms, when violent the breathing is
effected so that he is unable to utter a word,
or if lying in bed, the palpitation being considerable
it shakes the whole bed & sometimes
the room, the occasional symptoms are syncope,
giddiness, inability to sleep, horrid dreams
the pulse being irregular & intermitting sometimes
almost ceased at the wrist. Dr. T. doubts
wether this is ever an Idiopathic disease.
Your Diagnosis from the Palpitation is easy -
Your Prognosis depends on the remote causes
of the disease. The Proximate cause is chlonic
spasm of the heart. The Predisposing causes
are organic affection of the heart & arteries,
plethroric state of the vascular system, peculiar 
irritability of the heart, disease of the
Thoracic viscera. The Exciting causes are passions

292 
of the mind, stimuli applied to the stomach,
all that suddenly increases the action of the 
heart. Treatment this depends on the remote
cause, if Plethora, then Bloodletting saline
purgatives & antiphlogistic diet & &c. If irritability
of the heart Digitalis either in Infusion
Tincture or powder combined with the Mineral 
tonics are generally given with
considerable benefit also antispasmodics,
& an additional Tonic locally applied as
Calo: the app.n of a large bladder of ice to 
the part effected has often reasoned Palpitatio.
If there is organic disease of the heart,
or any thoracic viscus little hopes of a
cure can be looked for, what is then generally
employed are issues & seatons & Digitalis
with antispasmodics, & if Plethora is
present Bleed.
Genus LIV. Asthma. Cullen -
Difficult respiration occurring at intervals.

293 
with sense of stricture in the breast; expiration
with a wheezing noise; difficult
cough at the beginning of the fit; sometimes
none; but pus toward the end; & often attended
by copious discharge of mucous. 1. Idiopathic
Asthma Spontaneum, without evident cause,
or being accompanied with any diseases. 2. 
Asthma Exanthematicum from eruptions
or acid matters being repelled. 3. Asthma
plethoricum from a suppression of any usual
evacuation of blood, or from spontaneous
plethora. 2. Symptomatic. This is a disorder
of frequent occurrence, and unfortunately
one not under the controul of medicine.
It sometimes makes its attack suddenly, at
others is announced by symptoms which
proceed it as pain in the head, a sense of
oppression & tightness at the breast, drowsiness,
with a sense of resistance in the lungs,
the Patient now feels a sickness & makes a
more than usual quantity of urine,
the spirits are oppressed, the lungs feel 

294 
a degree of inactivity & stiffness, the
breast is more than commonly loaded,
there is a hoarsness, & now a difficulty of
breathing ensues which is performed with 
a wheezing noise, speech is a little impaired
cough, not able to respire except in an
upright posture, if the fit is violent there
is a palpitation at the heart, a livid 
colour of the face & the Patient feels as if
he should be suffocated. Asthma generally
makes its attack in the night,
especially when it comes on suddenly, the
fit commonly continues from midnight till
morning is far advanced, the pulse will
sometimes continue undisturbed except
when the attack is accompanied by a 
slight degree of fever, when the paroxysm
is gone off, the person falls into a sleep,
& generally finds when he awakes his
respiration almost if not quite free, but towards
the afternoon is troubled with flatulency

295
languor & drowsiness untill the evening
when another fit takes place, this is the mode
in which Asthma makes its early attacks -
after these Paroxysms occurring for a few
nights, there will be a remission in them, &
at last they will go off entirely; but most it
commonly leaves a disposition favourable
to its return, although this may not be the
case & the complaint never return, or continue
for five or six years & then cease. The Duration
of an attack is uncertain, but at its comment
seldom lasts longer than a fortnight,
When the attacks increase in frequency they
are of a longer duration; they at first return 
periodically as every Winter, then twice as
three times in the year & finally become
permanent in some persons, When the attack
is severe, there is great danger of Pneumonia
supervening. Your Diagnosis is
rendered very easy by its coming on in 
paroxysms. Your Prognosis depends on the 

296 
causes by which it is excited & the age
of the Patient. If the Patient is young, and
it arises from Plethora & over distention of 
the vessels, recovery will take place; but if
advanced in life, & has had the disease for
a long period combined with diseases of 
debility, then the chance of a cure is out
of the question. True Asthma is not considered
a disease of danger, provided there
be no inflammatory action. Asthma 
sometimes induces many diseases as Pneumonia,
hydrothorax, pulmonary consumption,
aneurism of the heart & arteries, anasarcous
swellings & in some cases respiration
has suddenly become short & quick
& paralysis has ensued. On examination
post mortem there is nothing satisfactory
discovered which point out its proximate
cause, in some cases an effusion
of serum has been found in the
air cells, which has been asserted by some
writers to be its proximate cause, but this

297
assertion Dr. Tuthill thinks very absurd,
the opinion of Dr. Cullen, & in which most
medical men coincide is that it arise from
a spasmodic constriction of the fibres of
the Bronchia. With respect to predisposition
it is hereditary, as we frequently find the
Children of Asthmatic Persons suffering from
the complaint; it is not incident to early
life, happens more frequently in the male than
the female sex. Plethora, malformation of
the Chest, certain morbid states of the stomach,
general weakness, advanced life
organic diseases of the heart of the heart
& arteries, water in the Chest, & the first of
all which we are acquainted with should
stand, the liability after an attack of its
recurrence, those all predispose to this disease.
The Exciting causes are the sudden repulsion
of eruptive diseases; external heat as a warm
room, the sudden suppression of discharges.
In those Patients in whom asthma is brought

298
on from external heat, changes of the weather
weather effect them, & whatever diminishes
the cavity of the thorax as a full stomach,
organic disease of the liver & spleens passion,
of the mind & exposure to cold are also classes
among the exciting causes. Treatment
Our main object here is the Spasmodic 
constriction to relieve, which if the Patient
be young is done by bleeding in
small quantity often repeated, except
when pneumonic inflammation supervenes
when the Patient is to have a large
quantity taken away at once; local
bleeding is often found beneficial by
cupping glasses applied to the Chest, &
taking away six or eight ounces afterwards
giving a mercurial purgative
then applying a plaister or poultice made
of bruis'd Garlic root to the chest, & promote
a free expectoration, as this tends to relieve

299
the Patient by the Pil. Scillæ. C. gr v per die,
as the action of the stomach is sometimes
disordered, occasioning heartburn - we must
employ those medicines recommended in
Dyspepsia; we may likewise give at night
a Bolus composed of Opium gr I Ext. Hyoscimi
gr v Conf. q. s -; Keeping the bowels at the 
same time gently open. Tr Digitalis grt xxv ter
in Die has been recommended in this disease,
also inhalations of Oxygen Gas by Dr. Beddoe,
but Sir George says there must be some objection
to the use of this, as when inspired it
has a tendency to inflame the lungs &
frequently this disease terminates in Pneumonia.
We must endeavour to prevent the
recurrence of this malady by correcting 
the predisposing causes for which purpose
we must recommend temperance and
exercise, the bowels to be kept laxative,
& giving medicines calculated to aid the

300
digestive powers - prescribe also change
of air, to a dry, settled, & warm atmosphere.
Generally speaking a Patient labouring under
this malady cannot exist in a warm atmosphere,
as that of a crowded room or city
but there are some persons with whom the
crowded air of a city agrees better than that
of the Country - The Diet must be light
& moderate; all that promotes acidity
or flatulency must be avoided, also
all fermented liquors. To change the climate
will be efficacious when winter approaches.
When Asthma is excited by other diseases
you must moderate the malady, as suppose
a Patient had been accustomed to
have a discharge from the hæmorrhoid
veins, & it is suddenly suppressed, then it
will be our practice to give Aloetic
pills or apply leeches to the verge of the
anus; if it proceeds from the sudden retropulsion
of eruptions, we must reproduce

301
them by Blisters, fomentations, liniments
& sudorifics. If there is a disposition or tendency
for Pneumonia supervening, Bleed instantly
& apply Blisters to the Chest. Antispasmodics
have been recommended in this disease as
Pil Gal. C. Mist Assafœtid, Æther &c. Smoking
the Bitter apple has been known to afford
relief. 
Genus LV Dyspnœa. Cullen -
Difficult respiration, continual; without
sense of stricture in the breast; but rather
of fullness & obstruction there; cough
frequent through the whole course of the disease.
Idiopathic. 1st Dyspnœa Catarrhalis
frequent cough bringing up much viscid
muscous. 2nd. Dyspnœa Sicca cough usually
dry. 3. Dyspnœa arica increased by every
change of the weather 3rd. Dyspnœa terrea
cough bringing up earthy & calculous matters -

302
5th Dyspnœa aquosa; urine in small quantity;
swelling of the feet; no fluctuation
in the breast, or any other characteristic
signs of water in the Chest. 6th Dyspnœa
pinguidinosa; in fat persons 7th Dyspnœa
Thoracica; from the parts enclosing the thorax
being hurt or ill formed 8th Dyspnœa
extrinseca; from evident external cause
Symptomatic of the diseases of the heart
or larger vessels; of abdominal tumour;
of various diseases -
Genus LVI. Pertussis. Cullen
Contagious; convulsive & suffocating 
cough; with a loud hooping noise at each
inspiration; often attended by vomiting.
In functionibus naturalibus. This complaint
differs from all the diseases of 
the order Spasmi in two particulars,
1st in being like the order Exanthemata
contagious, 2ndly. attacking Persons but once
during life. It is sometimes slow, & at others

303 
quick in forming. It generally makes
its attack with symptoms of common Catarrh,
the expiratory motions then become quick &
hurried, & performed with a convulsive action
making a hooping, & sonorous noise, which is
immediately followed by a convulsive cough;
this is repeated several times (that is both the
sonorous inspiration & cough) in general three
or four, when a quantity of muscous is brought
up from the lungs, after which the fit ceases
& the Child recovers, although sometimes it
is effected with difficulty of breathing & a sensation
of fainting which continues for a 
little time; these fits recur at uncertain
intervals. In the early part of the malady instead
of mucous, vomiting takes place and
the contents of the stomach are brought up,
when the Patient will complain of being 
very hungry, & will eat with acidity if food
is given him. The duration of Pertussis is 
uncertain; seldom if ever terminating before 

304
three weeks; commonly two months or more.
The Child, if capable of walking, will strive
to avoid the concussion gives to the frame
by the action of coughing, by laying fast
hold, when the fit is begun, to a chair or
wishes you to hold him tight round the 
body. The cough at the beginning is dry,
& the fits of coughing more frequent, but
as the disease advances a thick mucous
is brought up, when this takes place the
fits occur with less frequency; then will
be often during the fit a turgidity of the
vessels about the head & neck, arising from
the blood being impeded in its course thro'
the lungs, occasioning bleeding from the
nose &c. There is no fever at the commencement
of this complaint, but towards its
latter stage febrile symptoms are frequently
visible with exacerbations in the evening
but this does not necessarily follow; also it
is not necessary that the disease should be
attended with a cough of the hooping kind

305
for instance if a family of four Child -
are taken unwell, in three of whom all the
symptoms of Pertussis occur, but in the fourth
the whole of the symptoms except the hooping
cough are present, the Child having a 
cough, but not attended with a sonorous
noise, & by the disorder prevailing in the
other Children, you draw your conclusion
that it is Pertussis. In a violent fit of coughing
there is danger especially when the
Child is plethoric , as it frequently produces
convulsions. Suffocation has sometimes ensued,
when the Child has been so weak, as to
be unable to bring up the adhesive muccous
Hæmoptysis may take place, & induce pulmonary
consumption. Some writers have
asserted the seat of the disease to be in
the stomach, but this is erronerous. The
hooping is said to arise from spasmodic
action in the glottis. Your Dignosis is formed
from the hooping inspiration & convulsive

306
cough. Your Prognosis according to the
age of the Patient, if the Child is under
two years of age, it will suffer more than
older Children; from a calculation made
in London it has been discovered that by
for the greater number of those who die
of Pertussis are under the age of two years,
it has likewise been observed that Children
born of scrophulous or asthmatic Parents
suffer more severely from this malady
as well as from eruptive diseases. The
supervention of Pyrexia atteneded with a
dry cough are always to be looked on as 
unfavourable; but if the appetite continues
unimpaired, the Child soon recovering after
the fit is over, & following his amusement,
& a copious expectoration of mucous, the
Child will undoubtedly recover if no inflammatory
symptoms supervene. Hæmoptysis, 
& difficult respiration continuing
in the interval between the fits may prove

307
fatal, also convulsions. The exciting cause
is specific contagion. With respect to the 
predisposing cause, those who have never
had the malady are liable to it. Treatment
in conducting the cure it will be our
object to relieve the morbid secretion in 
the Bronchia & the spasm in the Glottis;
which is assisted by favouring expectoration,
& diminishing the morbid secretions.
There are certain diseases incident to our
frame, which last for a determinate period,
& to this class belongs Pertussis - there
are no remedies which will cure it in a
week from its commencement, tho' they may
be given to as considerably to alleviate the
malady; the spasmodic symptoms will often
continue for months; as this is not a necessary
property of the disease it may 
be stopt by proper medicines. In order to moderate
the complaint, we have the high
authority of Dr. Sydenham to Bleed & purge

308
but this practice is pursued now with 
relation to the habit of the Patient, if the
Child is of a plethoric temperament, & the disease
is combined with inflammatory action,
then taking away blood will be highly
requisite & giving evacuants, but where the
Child is of a contrary habit of body the
cure must be proceeded in a different way.
The Treatment recommended by Dr. Hepburn
is that which is now adopted, this is the
occasional exhibition of emetics as Ant.
Tart gr x vel Pulv Ipecac gr x after its action
is over give a mercurial purgative as Calomel
gr iij Pulv. Scam. C. gr vj vel viij; the
Diet must be of a mild Kind abstaining
from animal food, & taken only in
small quantities, if this plan is persevered
in the disease will often pass off without
any disagreeable consequences. Considerable
benefit has been derived from nauseating 
medicines as Ant. Tart gr I Mist Camph.

309
℥ij a tea spoonful of which to be taken
every two, three or four hours, the bowels at the
same time to be kept in a proper state
by Conf. Sennæ. & the mercurial purgative
to be occasionally repeated. If inf.n
supervenes then employ Blood-letting &
Blisters or a garlic plaister to the Chest
also rub it with Lin. Camphoræ ℥ij Ant.
Tart gr x. If the Spasmodic cough continues
it is to be stopt by sedatives, change of
air & tonic medicines. Some writers recommend
Cantharides to produce a stranguary
as Tr Lyttæ - but this Sir George
does not approve off - 
Genus LVII. Pyrosis. Cullen -
Burning heat in the epigastrium; with
copious eructation of an aqueous fluid;
generally insipid; sometimes acrid. 1st. Idiopathic,
sometimes [cross out] Symptomatic - In functionibus

310
naturalibus - This malady comes on slowly
& in process of time if neglected attains a
considerable degree of violence. It commences
with symptoms of dyspepsia, after a short time 
the pain attendant on this (dyspepsia) seems
to increase as well as the nausea & vomiting,
and at last the Patient observes that he
brings up by vomiting a watery fluid, at
first only in small quantity but which gradually 
increases to a pint two or three
times a day; after the rejection of this fluid
by vomiting the Patient is very much relieved;
he finds also that by taking food
these symptoms are alleviated. It is generally
considered that the pain is to be attributed
to the acrid fluid excoriating
the inner coat of the stomach. The fluid
is said to be a peculiar morbid secretion
of the arteries which ramify on the internal
coat of the stomach. It is evident says Dr.
Tuthill that whenever a considerable secretion

311
of this fluid occurs, that it must disorder
every function of the stomach as well
as other parts, debilitating the person, & his whole
frame waisting, which surprises him much
as his appetite has continued to increase.
The other secretions of the body are diminished
the skin being dry & the urine scanty -
This complaint is unattended by fever,
& continues for an uncertain period as it
may last for weeks or months. Your Dignosis
of it is rendered easy there being no malady
where a similar fluid is rejected from the
stomach. Your Prognosis is always favourable.
Its Proximate cause is supposed
to be a morbid action of the vessels which
ramify on the inner coats of the stomach.
With respect to the Predisposing & Exciting 
causes they are by no means well understood;
all that we know of the former 
is that it occurs in some Countries more
frequently than others. Treatment. The 

312
mode of treating this complaint says
Sir George has been very much misunderstood;
from our knowledge that food taken
in to the stomach afforded great relief,
some Writers concluded that the Patient
might be cured by emetics, but this is a very
erroneous conclusion, as emetics will not
only prolong the disease but weaken the
stomach. Astringents & sedatives are the
only proper remedies as a powder compound
of Opium in the Extract gr ss Pulv Alum. gr x
kind gr x. ter in Die or Infus. Catechu ℥iss
Alum gr x ad xv. Tho' all these will succeed
the chief dependance is to be placed on
the Opium which Dr. T. affirms he never
saw prove ineffectual. The Bowels if constipated
are to be kept open by Rhubarb
or Castor oil. If the rejected fluid be acid
then give x gr of Magnesia to every dose of the powder.
After the secretion has been stopped
the best remedies are Chalybeates as preparations

313
preparations of Iron, either the Sulphate or Subcarbonate -
Diet to be light, allowing no fermented 
liquors or hot infusions -
Treatment of Colica -
As the spasmodic contraction is the chief feature
of the disease our object will be first to relieve
it - this will in general be effected by freely evacuating
the bowels with Magnesia ℥ss Pulv Rhæi 2j
or Ol. Ricini ℥iss - suppose the stomach rejects this
medicine or it does not operate: the lower part
of the alimentary canal must be acted upon by
glysters of Ol. Terebinth ℥ss beat up with yolk
of an egg & mixed with tsp of thin gruel - The P -
should be put into the warm bath - if nothing
is retained on the stomach & the Turpentine gives
no relief, Tobacco injections should be resorted too
Inf. Tabacic ℥is. Cases are related where cold water
dashed on the abdomen has succeeded when all other
remedies had failed - we may also give the black
draught after the bowels are once opened, they
should be kept so by giving ℥ss Ol. Ricini daily.
When the effect remains after the exciting cause is
removed, sedatives may be given with antispasmodics,

antispasmodics, as Mist. Fœtid ℥vj cm Tr. Opii ʒj - Hyosciamus
is at present a favourite sedative - In
colica meconialis the warm bath & a tea-spoonful
of Ol. Ricini should be employed, which may
be mixed up with Syr. Rosæ. In Colica Pictonum
the best purgative is the Ol. Ricini, but as this
complaint advances slowly, it requires some medicine
of a more specific action to operate on
the poison as Hyd. Sub. gr I. on. or it may be combined
with Opium & given untill it effects
the mouth, producing a slight salivation. For
Colica Calculosa there is no certain cure; if the
disease be situated low down in the rectum, a
bougie may be passed up which will sometimes
relieve the stricture - In colica ceruminosa, 
purgatives such as particularly act upon the lower
part of the intestinal canal should be given -
for a child 3 years old Hyd. Sub. gr iij Pulv. Scam. C. gr vj
When Colica arises from Ascarides it is to be removed
by Turpentine injection, composed of Ol. Tereb ʒj -
For Tenia nothing is so successful as the Ol. Tereb - in
dose ʒss, it may be given in larger doses but Dr.
Fothergill says, he never know any benefit to be
divided by doing so - it may either be given by itself
or mixed with new milk - Tin filings have also been 

used & are supposed to act mechanically: they may be
given in doses of ʒj mixed with treacle, and as acidity
seems favourable to the production of worms, the mineral
alkalies will be found useful: strong purgatives are
also recommended such as Scammony & Gamboge:
The stiff hairs of the Dolichos Pruriens are very successfully
employed in Ascardios & Sumbrici; the pod is to be dipt
in syrup & afterwards scraped - dose ʒj - The root of the Spig -
Marilandica in sometimes used in doses of gr x ad xx: -
if after evacuating the bowels symptoms of inf.n should
supervene blood-letting & the antiplogistic regimen
must be restored too.
Treatment of Cholera Morbus -
The excessive secretion is the main object to be regarded 
and should be our only object to correct -
Those who have proposed first to evacuate the bowels
& afterwards to correct the secretion are evidently wrong,
if we were to wait untill the operation of a purgative,
in some instances, long before we had reason to expect
the medicine to have effected half its purpose, the
Patient would be dead. Besides the morbid & excessive
secretion of bile would not require such a remedy -
the best plan of proceeding is to give from 40 to 60 drops
of Laudanum & to be repeated in doses of 10 or 15 drops
every half hour after, untill the morbid action be diminished.
The Tr Opii may be given with Inf. Columbæ. 

The Patient should drink freely of light animal decoctions,
which are better than vegetable. If the vomiting should
immediately succeed the Tr. Opii it should be combined
with an effervescing draught - if all these fail opium
must be employed in injection, & if nothing remains
in the alimentary canal, friction on the region of the
liver, with the warm bath may be used, the latter being
well calculated to relieve spasm. If by such means we
are able to check the disease there will necessarily be
attendant a great prostration of strength. The best medicine
to promote the healthy action of the stomach
& bowels is the Inf. Columbæ - great attention must
be paid to diet: the animal broths must be continued 
for sometime: Some have recommended
Nitric Acid, but it is a medicine so inferior to
Opium as not to deserve notice.
Treatment of Diarrhœa
Our object is to diminish the excessive action
by removing the exciting causes, which if it can 
be done will in general cure the disease. In Diarrhœa
Crapulosa, where the intestinal canal is overloaded,
we must make use of purgatives as Calomel gr v
Pulv. Rhæi gr x, if this does not act freely, give an 
℥j of Infus. Sennæ every two hours untill it operates.
Castor oil is a good purgative - sometimes mild purgatives

purgatives may be employed with success as Magnesia,  
Rhubarb, & Aromatic confection: when the stomach
is disordered an emetic of Ipecacuan should
be given, but it is seldom necessary: if the peristaltic
motion still continue irregular notwithstanding to 
the removal of the exciting causes, sedatives ought
immediately to be given & if combined with a diaphoretic
will still be more efficacious as Pulv Ipecac
gr ss Pulv. Opii gr 1/6 Pil Hyd. gr ij omnibus ter horis -
In Diarrhœa Biliosa. the treatment should begin with
mercurial purgatives as Calomel, & afterwards small
doses of Opium & Calomel repeated every night &
morning: in Diarrhœa Mucosa our object is not
the removal but the correction of the morbid action,
for which purpose we give Mercury & Opium in
small doses; after the morbid action is allayed, Tonics
will be found useful, and astringents may
be employed with the Calomel & Opium as the Inf.
Catechu, Kino, Ext. Hæmatoxylon. Diarrhœa Celiaca
is usually symptomatic, but sometimes depends
upon enlarged mesenteric glands -: this complaint
is frequently incurable: In Diarrhœa Hepaticehœa
the disease is seated in general in the liver: here
again the best remedy is Calomel & Opium: Diarrhœa
linteria is the best relieved by Opium: when the
irritation is seated in the lower part of the canals

starch glysters with Laudanum will be found very 
beneficial: After all these different species of Diarrhœa
are checked, tonics will be found highly useful.
Treatment of Diabetes.
The main feature in this disease is the great quantity
of urine secreted, & our object will be to remove it.
Dr. Rollo found that by depriving the Patient of animal
food, the quality of the urine changed, & no longer
possessed the saccharine taste: however easy
this mode of living may appear to be, it will require
great resolution to put in practice, more is 
fact than the generality of persons posses - Opium. may
be rubbed externally & taken internally - the Nitric
Acid - the warm bath - blisters & issues are all used
to relieve the symptoms - Dr. Rollo chiefly relied on Hepatized
Ammonia in doses of iij ad iv gtt -: Astringents
as Catechu & Kino are useful; but Mr. Wats conceiving
it to depend upon inf.n action has employed blood-letting,
and in some instances with great success in 
cases of the most desperate Kind: the result of the same
treatment, says Sir George Tuthill, in London is by 
no means so favourable as described by Mr. Watts, still
there have been some persons cured by the above method.
Now suppose under any plan we succeed in stopping
the morbid action, our grand object will be to strengthen the

general system, and particularly guarding against costiveness,
and employing those remedies recommended
in Dyspepsia, whilst the Patient returns to a [cross out]
vegetable diet.
Treatment of Hysteria
Our object in the disease above is to diminish the morbid
irritability of the nervous system after the Paroxysm
is passed - Bleeding has been employed, but by some is considered
highly improper, yet Sir George thinks there are
many cases in which it might be useful & strongly indicated,
altho' it must not be resorted to where there 
is debility, but among the young & those who are of a 
plethoric habit it will be of essential service: to rouse
the Patient during the Paroxysm stimuli may be given
as Spt. Ammon. fœtid & succini, the temples at the same
time rubbed with æther, & the feet put into warm
water in obstinate cases glysters should be thrown up
of the antispasmodic Kind: if the Patient remains 
long in a state of stupor, food may be passed into the
stomach by means of an elastic tube introduced down 
the æsophagus, & as soon as the P. is able to swallow antispasmodics
may be taken; if accompanied by 
Heart-burn alkalies are useful: after the fit Valerian
is a good remedy in doses of ʒj or as large as the 
stomach can bear; or The Tinct. Mosch., Castor, Ammon. fœtid
with Camphor mixture. Opium is frequently the best

remedy in large doses both before & after the fit, 
also in shortening it, giving from ʒss to 40 or 60 drops,
small doses being of no use: The morbid irritability 
will be relieved by paying attention to 
the alimentary canal, and the food taken, this,
in young women who are of a full habit, is best
promoted by diminishing the ingesta & increasing
the excreta: Chalybeates, antispasmodics with
cold bathing are to be employed: Of Tonics the mineral
ones are the best combined with antispasmodics
as Pil Ferri, Myrrh, Mosch & Castor of each
gr v made into four pills taken every six hours:
at the same time the mind must be kept calm 
& at ease: warm bathing is sometimes useful: if the uterus
be effected attention should be paid to that organ (i.e)
if accompanied by retention of the menses our treatment
must be the same as mentioned under the
head of Chlorosis, but if accompanied by Menorrhagia
look to the cure under that head: if with Fluor Albus
our endeavour will be to stop the excessive discharge 
or secretion by giving the Zinci. Sulph. gr 1/4 doses, but it
should never produce nausea, for if does it ceases
to act as a tonic. 
21 Church Street,
Soho Square

Treatment of Hydrophobia 
When the disease is formed we can do no good: the only
period at which we can be of service is at the time
of receiving the injury: it seems probable that some
hours may elapse from the infliction of the injury
and the removal of the part without being attended
with much disadvantage, tho' the sooner it is removed
the better: some have advised cupping glasses to be
applied after the extirpation. Bleeding to the extent
of 100 ounces, Warm & Cold bathing, antispasmodics,
vegetable & mineral [cross out] poisons and alkalies have 
all been used without success at least with no
permanent advantage. -
Treatment of Tabes & Atrophia
Our main object will be to reduce the state of the
mesenteric glands, for which purpose we must
remove the exciting causes: the diet nutritious
but very moderate: the Child should be warmly
clothed & Kept warm, for indeed these diseases are considered
to be most frequently engendered by the
thinness with which Children are generally clad.
In this climate we commence our treatment by
giving the Patient a purge as Hyd. sub gr iij cm gr x -

Sennæ ℥j postguam quatuor horis, this should be repeated 
every third day after the bowels are evacuated
the best remedy is Iron: the Carbonate is prefered
because it is tasteless, giving gr 3 his teave in Die vel
Vinum Ferri grt xxx ad xxx: after a short time the Child
should be sent to the seaside, and tepid salt water
bathing adopted: if any acidity should prevail, it
must be corrected by alkalies: Sir George says that
however some may derive benefit from Mercury
he never yet said it succeed, and always found it
prejudicial in pulmonary constitutions.
Treatment of Pneumatosis.
In the treatment of this complaint our main object
will be the evacuation of the air, and the prevention
of further accumulation; for this purpose
pressure is to be employed by Bandages; also Liniment
of Ammonia & punctures made with the
lancet: If the ribs are fractured they should be
made to approximate & afterwards retained there.
If the breathing is much opposed blood-letting may
be resorted too, and is recommended by some
Authors of celebrity. 
London

Treatment of Tympanites 
Our object here will be the removal of the air, and
to prevent its return - to accomplish this antispasmodics
are occasionally recommended together with
aperients: the Spt. Terebinth ℥ss proves sometimes useful
The Mist. Fœtid cm Obrum Anisi, the Spt. Æther. C. ℥ss
added to each draught: the Bals. Peruv. gr xv cm Mist. fœtid
at the same time the bowels to be Kept open with Castor
Oil, Hyd. Sub, Ext. Colocynth. C. Some have used iced
water applied to the abdomen with advantage whilst
the body is bound round with a bandage: the Warm
bath, warm plaisters and liniments have all been
recommended, also introducing a tube up the rectum.
Suppose by any of these means the tone of the stomach
has been effected, the evacuation of the air
having previously taken place: the after treatment
to be adopted is to give tonics as in Dyspepsia also
aperients if inflammation supervenes no medicine
is of any avail.
Treatment of Hyrometra 
By sedatives and astringents.

Treatment of [cross out] Anasarca 
The main feature of this disease is the collected
fluid together with the causes our treatment therefore
will vary according to the remote causes. The removal 
of the fluid may be effected either by punctures
or indirectly by exhibiting medicines which act upon
and increase the action of the absorbents the latter
method is universally prefered, 'tho' it is very useful
at times to make punctures, but in advanced life
they must be made with caution, from the difficulty 
of healing them; the indirect remedies are.
Purgatives w.h are excellent medicines here, but quite
useless if merely given to evacuate the bowels, they
must be administered in sufficient doses to promote
plentiful evacuations of watery stools, the
Drastic purges are the best, the first of w.h Sir George
considers Elaterium in doses of gr I. but cannot be
continued without great caution, best debility should
be produced. If Elaterium is too powerful, combinations
of Scammony, Calomel, Colocynth & Gamboge
may be given in such doses as will produce numerous
stools. This is one mode of treating anasarca
with success, another 'tho a more uncertain
one, is diuretics; and medical men came to adopt
this practice from observing w.h was produced by
what they termed critical evacuation of urine.

the best diuretic is the following 1/3 gr. of the Hyd. Sub. gr v
of Scillæ & one of Digitalis made into pill & taken
three times a day: letting the Patient drink freely
of a saturated solution of supertartrate of Potash
this will commonly succeed, if not, try the Decoct.
Allii Poni & the Potassæ. Tartras, or the Potassæ supertartras
dissolved in Decoct. Tarax. with the addition
of Spt. Juniper, or the Potassæ Aceta, dissolved in some
decoction with Spt. Æther. Nitrici ʒs, and lastly if these
do not succeed give the purgatives & diuretics combined.
Although vomiting is sometimes successful,
yet the employment of such remedies produce
so much weakness as to inquire rather than do good.
When the extremities only are effected pressure by
means of a roller, friction, exercise & mercurial
frictions must be used. Suppose the Liver to be
the cause of the disease, we may give relief
by only improving the action of this viscus: after
the removal of anasarca - the strength should be
supported by chalybeates and Bitters with nutritive
and plain diet
1 or 24  Extracts from Blackall -
Blackall (M.D.) in his observations on
the nature & cure of dropsies, a parts
that be found Squill by for the most
forms a part diuretic, the tincture of which
to be given in the pollent quantity which

the patient can bear without vomiting  
or sickness - In this manner it may be
exhibited daily three times, & commencing
with thirty drops the quantity may be increased
to forty or fifty. The mistura ammoniaci 
& spt. Æther. Ritrici seem to assist its
operation - In removing glandular obstructions
the preparations of mercury are considered to
hold a principal rank. Its assistance as a diuretic
is undoubtedly not inconsiderable.
For when the squill does not act entirely as
could be wished, the addition of a grain or
two of mercury (calomel) every night is frequently
followed by a great flow of urine, at the same time
that the salivary glands are affected. These patients
bear purging badly, & the operation seldom carries
off much water - (urine not coagulable by Heat.
Anasarca & general Dropsy in which the urine is
coagulable by heat the above writer observes,
that Digitalis is a sovereign remedy, & he knows
in no instance where it has failed when
properly exhibited, & adds that it is equal to
almost every emergency, short of that destruction
of facts which admits of no cure 
after the Digitalis giving bark to recover the loss

in Anasarca arising from drinking cold 
water, be found cream of tartar in large
doses a good remedy, afterwards Bark
New Remedy for Toothache.
Sulphuric Æther, saturated in the cold with
Camphor, & then a few drops of Liq. Ammoniæ
added. It acts as a cautery. M. Coltescase,
who has employed it for 4 years, says it is always
attended with success. The rapid evaporation
of the Æther causes a slight deposit of Camphor
in the dental cavity, & this protects the acne from
the air. The Ammonia cauterises. Oct. 23rd. 1846
Mineral Poisons -
M.M. Tandras & Bouchardat recommend as an
universal antidote for the mineral poisons. The
Per sulphuret of Iron in such quantities as to be
always in excess in the intestines, to prevent the
reabsorption of the poisonous matter. They administer
first a purgative, order a soap bath, then give the
Patient a Mixture of Syrup & Per sulphuret of Iron
night & morning. Opium, strychnia, or belladonna
may be employed at the same time. Two Cases only
proved fatal not of 122 with lead colic thus heated,
& the others were rapidly cured. Oct. 1846
On the means of Preventing Bed - sores -
The thicker the cuticle, the more it will protect
the parts beneath; you may, if you attend to it, 

in time, add to the thickness of the cuticle by stimulating  
the surface of the skin. Nurses know
this very well, for when Patients are Bedridden, they
wash the parts subjected to pressure, with brandy.
What is still better is a Lotion composed of two grains
of Bichloride of Mercury to an ounce of Proof
Spirits. When you think that a Patient is likely
to be confined so long in bed that sloughs may be
found on the Os Sacrum, begin at an early period
to wash the parts two or three times a day with this
Lotion. I have found it useful in other cases
where a patient suffers from pressure. For example,
in a case of Hernia which requires to be
supported by a very powerful truss the truss
galls & frets the stein, & may at least cause inflammation
& sloughing; but, under the use of 
of a stimulating Lotion, a thicker cuticle is 
generated, & such mischief is avoided -
Sir B. Brodies' Lectures on Pathology & Surgery
June 5th 1846
The Acetum Colchici, neutralised with Magnesia
is considered by Sir C. Sendamore, the best formula
for Gout, as it is inoffensive to the stoamch, & certain
in its effects on the Bowels. Dose ʒss to ʒiss
Hydrocephalus.
The external application of Mecury may be ordered
to be rubbed in or smeared on the leg (inside/every
twelve hours, & covered with a stocking made to tie
lightly above the knee. Small doses of Iodide of Potassium
(one gr. every three or four hours) may be also given (Braithwate)

Delirium Tremens - 
Whilst the Tongue & Mouth are moist, & urine
abundant, don't be afraid of giving Opium
for the purpose of procuring sleep when needed;
but be careful if these symptoms are not present.
(Dr. Corrigon)
Epilepsy
Iodide of Potassium three grs. three times a day,
& the mouth to be affected by blue pill -
Dr. White
Neuralgia
Apply a Blister as soon as possible to the trunk
of the nerve, & sprinkle upon the surface from
half a grain to a grain of Morphia every morning.
Attend to the general health at the same
time, giving internally every night pil. hydroxy. pil
aloes. ext. Acet. Colchici. āā gr iij, and five grains
or Iodide of Potassium thrice a day in any convenient
vehicle. This endermic method has
succeeded when leeches, blisters, noxious, belladonna
arsenic, iron, iodine, turpentine, & guaiacum have
entirely failed - Dr. White -
Hæmorrhage from the Nose
Introduce the little finger into the nostril, and
press upon its flow until the bleeding stops; then
take a dossil of lint, & roll it upon powdered
alum, & press it upon the floor of the nostril
with the little finger. Introduce pieces of lint?
in this way until the roof of the nostril supplies
the pressure of the finger. (Dr. Oke)

Fumigation recommended by Herapath 
in time of Cholera. Fumigate 3 times
a day with the under mentioned substances.
= A mixture of 3 parts of common
salt and one of Black Oxyde of Manganese
placed just inside the street
door of the the House, & a little common
vitriol poured upon it. Oct 1847 -
Cholera. (Asiatic) Three objects are to be
observed in its treatment. viz. 1. To moderate
the morbid action established for expelling
the poison, by replenishing the fluids. Give
the Patient a fluid for drink, consisting, as
nearly as possible of similar elements to the
serum, as albumen, muriate of soda, and 
carbonate of soda in a very diluted state; give
also effervescing salines. 2. To prevent local engorgements,
particularly of the liver & venæ
portæ. Remove a quantity of blood proportionable
to the Exigency of the case, & the organ congested.
3. To promote healthy secretion, & allay
pain, irritation, & spasm. Give Calomel and
Dover's powder freely, until the vomiting and 
purging are restrained. (Mr. Clarke) -

Cholera. (Asiatic) Take thirty grains of Sesquicarbonate 
of Soda or BiCarbonate of Potash,
put it into a tumbler glass, & add a wine
glass of water & a little Syrup. Then dissolve
twenty grains of tartaric or citric Acid in half
a wine glass of water, & let the patient drinks it
off immediately. Lemon juice maybe substituted 
for the Citric Acid. The carbonic
acid is said to act as an antidote to the
poison in the system. (Dr. Parkin) -
Cholera (Asiatic) Loss of power in the heart
is said to be one important lesion in cholera,
and nature, therefore, endeavours to remedy
the disease in four ways; which we ought
to study, viz. 1. Vigorous muscular pressure
(by cramps) which proper the tarry blood towards
the heart. 2. The Absporption of the water restores
the blood to its natural or liquid condition.
3. Nausea, by causing general relaxation of 
the system, diminishes the obstruction to the
passage of the blood in the vessels. 4. Reteching,
or vomiting, assists mechanically in drawing for
forward the blood in the distant congested
vessels. (Mr. French)
Cholera (Asiatic) First give calomel, rhubarb,
aloes, ā ā gr x pt. Bolus; then Liquor. Ammon. m.x

and repeat in half hour doses if rejected. 
Effervescing draughts, soda water, liq. ammonia
externally over the chest, abdomen, & upper and
lower extremities as a rubefacient, vinegar &
water to the head. Convalescent Treatment.
A laxative after the second or third day,
& tonics for a week afterwards. Use opium
cautiously. For the spasms or cramps, stretch
the lower extremities, taking hold of heel &
toes & send the toes & foot towards the patient
as he lies gently & repeatedly. Use also shampooing.
(Ollapod, of Madras) -
[cross out] Diarrhœa. Try Acetate of lead for obstinate 
cases of Diarrhœa, accompanying
uterine phlebitis and peritonitis. This medicine
seems to act by [word crossed out] checking the peristaltic
action of the intestines, & allaying pain
by blunting the sensibility of the mucous 
membrane. (Dr. Smyth.)
Dysentery. Battley's solution of Secale
one drachm; Tinct. of Muriate of Iron, one
drachm; water six ounces. Mix, & give a
quarter part every four hours. (Mr. Gervis)
Nephritis. Give Copaiba in ten drop doses 3 times
a day, in cases of Nephritis with suppression of urine,
after bleeding & the ordinary treatment have failed.
(Mr. Robarts)

On Chronic Diseases of the Stomach 
By Wm. Strange. M.D. M.R.C.L.E.
The treatment in simple cases comprises
two heads; first, to relieve the present
pain; and, secondly, to restore the healthy
condition of the digestive functions.
" For my own part, I feel confident
that the application of rubefacients to the
stomach, as a large mustard poultice,
& of warmth to the surface of the body,
& the feet especially, & at the same time
the exhibition of a mild sedative, will
be found to answer best. For the latter
purpose, one grain of the Ext. of Belladonna,
made into a Draught with two drops
of hydrocyanic Acid, & an ounce of 
Camphor Mixture, will be a good formula.
In slighter attacks, accompanied with 
liquid or flatulent eructations, half a 
grain of the Ext., made into a pill with
four grains of Bismuth, & a drop of essential
Oil of Peppermint, to be repeated every

four or six hours. I have found of great 
service. To fulfill the second indication,
vegetable bitters, & mild preparations
of iron, particularly the citrate, along
with. Bismuth & Rhubarb, may be had
recourse to. "Prospects of Medicine 1845
Treatment of Infantile Gastric Fever
By Golding Bird A.M. - M.D.
The origin of Gastric fever occurring
among Children is usually to be ascribed
either to unhealthy ingesta, or depraved
secretions. The Pulv. Sodæ. C. viz.
℞. Sodæ. Carbonate. Exsiceatic ʒv
Hydrargyri. Chloridi ʒj
Pulv. Cretæ. Compositi ʒ Misca
in doses of from three to eight grains
at nights & a full dose of the Pulv
Rhæi Salin - viz. ℞: Pulv. Rhæi ʒj
Potassa. Sulph ʒij # 
every Morning for a week or so will
in most cases be found very successful
treatment.
Guy's Hospital Reports April 1845
page [cross out] 118

Remittent Fever. The treatment in these 
cases, says Dr. G. Bird, is exceedingly
simple. First, remove the Hair, wash
the body daily all over, & put the patient
on low diet; and after clearing the
bowels with Hyd. c. cretæ, or ol. Ricini,
give Sodæ. Sesquibarb., untill the state
of the secretions is corrected, quinine
then given acts almost like magic,
curing the patient generally in a week
Guy's Hospital Reports
April 1845
page 116
Prescription of Mr. Varbridge for Chronic
Inflammation of the elbow joint -
inflammation of the bursa under the extensors -
℞: Iodini gr LXIV
Potas: Iodid: ℈ij
Spt. Vini. Rect: ℥j
Applicand semel vel bis in diebus septem
Ligua "Iodine Paint -
March 19th - 1849

Formula used by Monsieur Biet for the Itch 
Sulphur Sublimat - two parts
Potass. Subcarb - one part
Adeps Suillæ - eight parts
Half an ounce of this Ointment to be
rubbed in night & morning - This generally
affects a cure in ten or twelve days -
Observation on Cholera by Sam.l Rogers, Surgeon
of the Madras Army - 1848.
"It is neither contagious or infectious -
"That Cholera has its origin in other than
human sources, & that the communication
of the sick with the healthly is not necessary
for its diffusion -
"That Cholera may be in many cases averted,
& its mortality much lessened by proper precautionary
measures being adopted.
"The first material cause of Cholera is now
generally admitted to be a specific poison,
which, acting through the nervous centres, produces 

its deleterious effects by destroying the vitality 
of the blood -
"For the development of the disease certain exciting
or accessory causes are requisite, as
some sudden meteorological phenomena, brought
about by a storm of thunder & lightening, accompanied 
by a heavy fall of rain in the hottest weather.
Crouding large bodies of men into small imperfectly
ventilated buildings - Decomposition of animal
or vegetable matter, & effluvia arising from 
foul drains - Sleeping, particularly or the ground,
in low swampy situations - Impure emanations
arising from congregations of large bodies of men,
whose constitutions are highly susceptible of disease
from some particular circumstances -
"To produce the disease in full activity certain
accessory agencies are [cross out] requisite - that there exists
a primary essential cause - a specific poison -
& that on a combination of these two conditions
taking place, persons who are predisposed, either
from their general habits of life, or some temporary
circumstance in their condition, become
the victims of the poison -
a) Persons are frequently known to be attacked
with Cholera who have taken a dose of purgative

medicine, [cross out] particularly aperient salts. 
"Mr. Twining says that he has known an
attack of Cholera result from the administration
of every sort of aperient medicine,
except castor oil, during the prevalence of an 
epidemic - One Officer lost his life from
taking a seidlitz powder, & another from a dose
of colocynth -
"During the prevalence of epidemic Cholera
grest precaution therefore is obviously necessary
in the use of purgatives, as the disease
may be called into existence by the over-action
of such medicines -
"The affection of the brain existing in this 
disease is peculiar - a degree of drowsiness,
from which the patient is easily roused to 
give a correct answer to questions, but he soon
irresistibly relapses, nor can he answer many
questions at one time -

Rationale of treatment pursued in Cholera Asiatic by J. Lawrence 
of the 34th Reg.r of Native light [cross out] Infantry in 1837
"Generally on admission on a full dose of Calomel
combined with two grains of Opium was given,
followed by a draught of Ammonia, Æther, Tincture
of Cloves and forty minims of Laudanum in a little
Camphor Mixture or Spirits & water, & if rejected both
Bolus & Draught. When the stomach became tranquil
the Calomel was prescribed in small doses combined
with Capsicum every three hours, & the stimulating
Draught continued as circumstances indicated.
In a few instances Mustard emetics were prescribed
without any beneficial effects from their operation.
When the [cross out] depression was great, the usual diffusible
stimuli, such as Ammonia, Æther, Brandy, or Port
Wine were had recourse to; but a decided preference
was given to Ammonia, & I think it possesses this advantage
over the other stimuli, that it can always
be repeated at short intervals, & in increasing
doses according to the degree of sensibility remaining
in the stomach. I have therefore prescribed it
in doses of ten to fifteen grains mixed with a little
Brandy & water, every ten or fifteen minutes in cases of
extreme collapse, & in several instances with decided
effect. Saline effervescing Draught & Soda Water mixed
with a little Brandy, & from forty to sixty minims of Tinct.
Opii, were in some instance, substituted for the Ammonia
& Æther, for the purpose of alloying the vomiting; and 

Soda Water for drink. Subsidiary to the internal treatment 
were the application of sinapisms to the epigastrium, 
spine, & extremities, & hot epithems, & frictions
of turpentine - Hot sand bags to the feet were never 
omitted -
Treatment by Dr. Grail of the 31st. Regiment -
The Pill I now usually prescribe is Calomel, Blais 
Capsici āā grs. [cross out] i, Opii gr iss, Assafœtida gr ij, which
if rejected is shortly afterwards repeated; but if 
retained & the purging continues

  




 


 


Antidotes to Poisons Continued -
Preparations of Lead - Give Emetics - Sulphate
of Magnesia dissolved in mucilaginous fluids;
Opiates to allay spasm: warm bath: Castor oil & purgative
clysters of Inf. Sennæ vel Colcynth - Tests - Sulphuric
Acid & the alkaline sulphates form an insoluble white
precipitate - Chromate of Potass forms a yellow -
Potass, Soda, & Ammonia. Give some mild acid to
neutralize the alkali as vinegar, diluted lemon juice
also mucilaginous drinks. - Tests- Alkalies change
violet colours, of a green colour & turmeric paper brown.
Muriate or Nitrate of Barytes - Give Sulphate of
Soda, Magnesia, or Potash dissolved in some mucilaginous
fluid, to be drank freely - they form an
insoluble sulphate, which is inert -
Sulphuric, Nitric, and Muriatic Acids - Give
calcined Magnesia if at hand; if not Soap, Chalk
or the Alkalies diluted - Test - they turn vegetable
thus red: Oxalic, Tartaric, Fluoric & Nitric Acids the same
mode of Treatment to be pursued as in the above.
Potassa Nitras - Give emetics, mucilaginous
drinks, milk & emollient & purgative glysters - Tests
Detonates on burning coals: when mixed with Sulphuric
Acid, red nitrous fumes escape -
Phosphorus - It is advisable to expel this as speedily 

as possible from the stomach - it has been recommended 
to distend the stomach with food & then to excite
vomiting & to give diluents freely -Test. if dissolved
in Oil it is luminous in a dark room -
Opium - Give Sulphate of Zinc gr viij or x every ten
minutes till vomiting is excited or Sulph. Cupri gr I
ad iij: tickle the throat with a feather & use every possible
means to evacuate the stomach: if the Patient cannot
swallow it will be advisable to pass an elastic tube
down the œsophagus & thus introduce emetics. In some
cases it will be proper to open the jugular vein to relieve
the vessels of the brain from a state of congestion. If
scarcely any pulse Wine, Brandy & Ammonia should
be introduced into the stomach. Acids should never
[cross out] be given untill we are quite convinced no Opium
remains in the stomach. Active purgatives both by
the mouth & per anum - Coffee may be drank freely -
Children are much injured & sometimes destroyed by the
too few use of syrup of Poppies, in such cases give Ammonia,
Brandy diluted & wine with the warm bath -
We use the same treatment when Conium Maculatum,
Hyosciamus niger, Lactera Virosa, Cicuta Virosa,
Atropa Belladonna, Aconitum Napellas, Nux vomicae
Angustura Pseudo Ferruginea or Laurus Camphora
be taken -
Prussic Acid - Give Ammonia, Brandy & oil
of Turpentine in small doses conjoined with artificial 
aspiration if required

Dr. Nuttall recommends the following application
in Prurigo, the beneficial effect of which I 
have myself witnessed, whilst a pupil of the above
Gentlemans - ℞: Ung. Hydrag - ʒij Ung. Sulphur ℥j
Pulv. Opii grv #gr. -
Also the following in Diarhœas, Cholera Morbus &c
℞: Pulv. Ipecac. gr ss Pil Hydrag - gr ij Pulv. Opii gr. 1/6
#. Cap.d omnibus duabus horis -
Also the following Suppository for the Diarrhœa
incident to pregnant Women ℞: Ext. Catechu
Ext. Hæmatoxylon ā ā gr x Pulv. Opii gr I # - intro
ductum sit in anum -
Antidotes to Poisons taken internally -
Oxyde of Arsenic- Give an Emetic, if vomiting has
taken place & afterwards Milk, white of egg & mucilaginous
drinks -
Hydrargyri Oxymurias - Give White of Eggs & milk
immediately - (the former decomposes Corrosive sublimate
& throws down on insoluble salt, mild in
its operation) then give Barley water or linseed tea to
wash out the stomach afterwards saline purgatives 
by the mouth, with emollient clysters -
Antimonium Tartarizatum - Give Decoction of

Oak - Bark, Infusion of Galls, or Common Tea, all
these decompose it - if stomach irritable give Opiates -
Tests - with Sulp. Acid. forms a white precipitate, the same
with alkalies, & an yellow one with the Oak Bark & galls -
For Antimonii Murias, the same treatment -
Subacetas Cupri vel Verdigris - Give milk, white of eggs
sugared water & mucilaginous fluids freely: if there is
spasm Opiates will be useful: emollient clysters - apply
the same treatment to Sulphate, Nitrate, Muriate,
Carbonate & Oxyds of Copper & wines - Test - When Lq. Ammoniæ
is added to these salts it turns them green (ie)
forms a green precipitate; but if added in excess, the precipitate
becomes dissolved, & a beautiful blue solution
of the Ammoniant of Copper is the result -
Muriate of Tin - Give an emetic if necessary afterwards
milk & mucilaginous fluids; emollient
& oily clysters also opiates to allay spasm. Test. with
Nitro muriate of gold it forms a brownish red or purplish
precipitate - treatment the same for all pulv. of Tin.
Zinci Sulphas - Give alkalies, Magnesia or Chalk
after this diluents & clysters: & opium if spasm be present.
Test. It forms with alkalies a white precip - with Precipitate
of Potass a blue precip - 
Argentic Nitras - Give mucilaginous fluids in w.h
common salt has been dissolved, w.h forms a Muriate
of Silver insoluble & harmless - Tests - with alkalies it
forms a white precip - the same with Muriatic Acid
but w.h soon turns black

Diseases Page
Intermittent Fever 1
4
Tertian - the
Quartan - the
Quotidian-  16
Continued Fevers 16
Synocha 17
Typhus 31
Synochus 48
Phlegmasiæ 60
Phlogosis 60
Opthalmia 71
Phrenitis 72
Cynanche 83
Cynanche Tonsillaris 85
Cynanche Trachealis 91
Cynanche Parotidea 95
Cynanche Pharyngea 97
Pneumonia 98
Peripneumonia 101
Pleuritis 101
Carditis 111
Peritonitis 114
Page
Gastritis 116
Enteritis 121
Hepatitis, Acute 124
- Do -, Chronic 131
Splenitis 134
Nephritis 141
Cystitis 154
Hysteritis 160
Rheumatismus 166
Acute 167
Arthrodynia 175
Podagra 179
Variola 199
Varicella 220
Rubeola 223
Adynamiæ 234
Syncope 234
Dyspepsia 242
Hypochondriasis 249
Chlorosis 256
Spasmi 263
Tetanus et Trismus 264
Convulsio 275
Chorea 277
Raphania 277
Epilepsia 277

Palpitalio 289
Asthma 291
Dyspnœa 301
Pertussis 302
Pyrosis 309
Colica 313
Cholera Morbus 315
Diarrhœa 316
Diabetes 318
Hysteria 319